1
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Halbeisen G, Braks K, Huber TJ, Paslakis G. Exploring Gender Differences in Early Weight Change and Variability in Adolescents with Anorexia Nervosa during Inpatient Treatment. J Clin Med 2024; 13:3255. [PMID: 38892966 PMCID: PMC11172843 DOI: 10.3390/jcm13113255] [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: 04/30/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Adolescents' early responses and overall outcomes during anorexia nervosa (AN) treatment may differ by patient gender, raising the question of whether evaluating clinical data during AN treatment may require different criteria. Methods: We investigated, using patient records, whether young men and young women with AN differed in terms of early treatment response (defined as weight change and variability within the first 14 days) and whether early treatment responses predicted treatment outcomes similarly across genders. Results: Weight changes predicted patient discharge weight across all gender groups. Weight variability predicted higher disordered eating psychopathology and higher body image insecurities at discharge. Gender differences emerged only for weight gain, which was more pronounced for young men, and gender modulated the effects of weight gain and variability on general psychopathology outcomes. Conclusions: The present findings suggest that early weight changes and weight variability are similarly important predictors of AN treatment outcomes in adolescents but also hint at possible gender differences in terms of the link between weight change and, respectively, variability on general psychopathology.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32123 Luebbecke, Germany;
| | - Karsten Braks
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany
| | - Thomas J. Huber
- Centre for Eating Disorders, Klinik am Korso, 32545 Bad Oeynhausen, Germany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, 32123 Luebbecke, Germany;
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2
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Monaghan M, Doyle L. 'It stopped you thinking about food' - The experiences of mealtimes and attending a post-meal support group for young people with anorexia nervosa. Int J Ment Health Nurs 2023; 32:128-138. [PMID: 36082875 DOI: 10.1111/inm.13068] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/14/2023]
Abstract
Anorexia nervosa presents as an international public health concern as it is the mental health problem with the greatest risk of mortality, and the average age of onset is decreasing. For those experiencing anorexia nervosa, mealtimes have long been recognized as a difficult and distressing time when young people need additional support. However, the post mealtime period can be associated with even greater distress, yet there is little research on interventions to support young people in this vulnerable time, and even less on how young people experience these interventions. This study, therefore, explores young peoples' perceptions of mealtimes and a post mealtime support group. Using a qualitative descriptive design, telephone interviews were conducted with a purposive sample of six young people who participated in a post-meal support group while an inpatient in a Child and Adolescent Mental Health Unit. Using a semi-structured interview guide, participants were asked about their experiences of this support group and their perceptions of how to improve this intervention. Content analysis resulted in the development of three themes: 'The Challenges of Mealtimes and Post Mealtimes', 'The Benefits of Post-meal Support Groups', and 'Improving Unhelpful Aspects of Post-meal Support Groups'. Findings are reported in accordance with COREQ guidelines and suggest that for young people experiencing anorexia nervosa, post mealtimes are often more distressing than the meal itself and that participants found post-meal support groups to be a helpful intervention in reducing post-mealtime distress. Post-meal support groups can be improved by ensuring a consistent approach from staff and providing staff with the training and knowledge required to support those affected by eating disorders.
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Affiliation(s)
- Margaret Monaghan
- Children's Health Ireland, Temple Street Children's University Hospital, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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3
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Keegan E, Byrne S, Hay P, Touyz S, Treasure J, Schmidt U, McIntosh VVW, Wade TD. An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa. J Eat Disord 2022; 10:83. [PMID: 35715854 PMCID: PMC9206373 DOI: 10.1186/s40337-022-00602-0] [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: 11/26/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE People with anorexia nervosa often exhibit inefficiencies in executive functioning (central coherence and set shifting) that may negatively impact on treatment outcomes. It is unclear from previous research whether these inefficiencies can change over treatment. We aimed to (1) investigate whether executive functioning can improve over treatment, (2) determine whether baseline executive functioning moderates treatment outcome, and (3) examine whether baseline executive functioning predicts early change (i.e., increase in body mass index over the first 13 weeks of treatment) or remission. METHOD We conducted linear mixed model and logistic regression analyses on data from the Strong Without Anorexia Nervosa trial (Byrne et al. in Psychol Med 47:2823-2833, 2017). This study was a randomised controlled trial of three outpatient treatments for people with anorexia nervosa: Enhanced Cognitive Behavioural Therapy, Maudsley Model Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management. RESULTS While set shifting clearly improved from baseline to end of treatment, the results for central coherence were less clear cut. People with low baseline central coherence had more rapid reductions in eating disorder psychopathology and clinical impairment than those with high baseline central coherence. Baseline executive functioning did not predict early change or remission. DISCUSSION The detail-focused thinking style commonly observed among people with anorexia nervosa may aid treatment outcomes. Future research that is more adequately powered should replicate this study and examine whether the same pattern of results is observed among people with non-underweight eating disorders.
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Affiliation(s)
- Ella Keegan
- Discipline of Psychology, Blackbird Initiative, Órama Research Institute, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - Susan Byrne
- SWAN Centre, Perth and School of Psychology, University of Western Australia, Perth, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- InsideOut Institute, Sydney University, Sydney, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Kings College London, London, UK
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury Christchurch, Christchurch, New Zealand
| | - Tracey D Wade
- Discipline of Psychology, Blackbird Initiative, Órama Research Institute, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
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4
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Wade TD, Allen K, Crosby RD, Fursland A, Hay P, McIntosh V, Touyz S, Schmidt U, Treasure J, Byrne S. Outpatient therapy for adult anorexia nervosa: Early weight gain trajectories and outcome. EUROPEAN EATING DISORDERS REVIEW 2020; 29:472-481. [PMID: 32838476 DOI: 10.1002/erv.2775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/10/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. METHOD Participants (n = 120) were randomised to one of three outpatient therapies. RESULTS Four latent classes were identified; two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m2 at initial assessment, and both gained significantly more weight over the 13 sessions compared to the other two classes. The third and fourth classes (middle, stable and low, stable) had an initial BMI of 16.44 and 15.31, respectively, and neither gained weight over the first 13 sessions. Compared to the other three classes, the higher, rapid class (N = 19, 16%) showed a significantly greater BMI increase over the first 13 sessions of therapy and a significantly higher rate of remission at end of treatment and 12-month follow-up (18-22 months post-randomisation). CONCLUSIONS The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Karina Allen
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research and the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Anthea Fursland
- Centre for Clinical Interventions, Perth, Western Australia, Australia.,Western Australia Eating Disorders Outreach & Consultation Service, Perth, Western Australia, Australia
| | - Phillipa Hay
- School of Medicine & Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
| | - Virginia McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Stephen Touyz
- School of Psychology, Sydney University, Sydney, New South Wales, Australia
| | - Ulrike Schmidt
- Department of Psychological Medicine, Kings College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| | - Susan Byrne
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
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5
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Chatelet S, Wang J, Gjoertz M, Lier F, Monney Chaubert C, Ambresin AE. Factors associated with weight gain in anorexia nervosa inpatients. Eat Weight Disord 2020; 25:939-950. [PMID: 31119585 DOI: 10.1007/s40519-019-00709-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Nutrition restoration in inpatients with anorexia nervosa (AN) is a core element in treatment, enabling recovery of cognitive functions essential for psychological care. This study aims to identify factors associated with inpatient weight gain. METHODS Medical records from 107 inpatients aged 13-55 years with AN, hospitalized for more than 7 days at a specialized unit, were examined in a retrospective study. Weight evolution graphs were created for each patient and graded independently as optimal, moderate, and inadequate weight gain after 2 weeks and increasing, flat or decreasing weight in the first 2 weeks by expert clinicians. Driven by explicit hypotheses, bivariable analyses were carried out to detect relevant factors associated with weight gain during and after the first 2 weeks of admission. RESULTS Initial weight gain in the first 2 weeks of hospitalization and the introduction of a protocol harmonizing treatment procedures around rapid refeeding were strong factors associated with optimal weight gain after 2 weeks of hospitalization, whereas prior hospitalization in a psychiatric unit, diagnosis with binge-eating/purging subtype and age over 18 years were significantly associated with inadequate weight gain (p < 0.001-0.05). CONCLUSION To promote weight gain during hospitalization, clinicians should consider the following therapeutic measures: rapid refeeding strategies, renutrition protocols, and controlling purging behaviors. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Solène Chatelet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jen Wang
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland
| | - Mathea Gjoertz
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Françoise Lier
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland.,Vaudois Centre for Anorexia and Bulimia (abC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carole Monney Chaubert
- Etablissements Hospitaliers du Nord-Vaudois (eHnv): St. Loup Hospital, Pompaples, Switzerland
| | - Anne-Emmanuelle Ambresin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland.
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6
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Gregertsen EC, Mandy W, Kanakam N, Armstrong S, Serpell L. Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis. Psychiatry Res 2019; 271:484-501. [PMID: 30551081 DOI: 10.1016/j.psychres.2018.11.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.
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Affiliation(s)
- Eva C Gregertsen
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - William Mandy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | | | | | - Lucy Serpell
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, London, UK
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7
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Inpatient weight curve trajectory as a prognostic factor among adolescents with anorexia nervosa: a preliminary report. Eat Weight Disord 2018; 23:645-651. [PMID: 28710742 DOI: 10.1007/s40519-017-0415-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate the predictive value of weight restoration trajectories for relapse within the first year after discharge from inpatient treatment among adolescents with AN. METHODS Forty four inpatient adolescents (5 boys, 39 girls) aged 11-18 (M 14.85, SD 1.87) diagnosed with anorexia were assessed at admission and discharge from a general hospital inpatient ward. Re-hospitalizations within 1 year of discharge were recorded. Factors assessed included 1/BMI at admission, 2/BMI at discharge, 3/percent from target weight (PFTW) at discharge, 4/length of hospitalization, and 5/a weight restoration trajectory measuring weight drops during inpatient weight restoration (rates of negative cubic variation in body weight (NCV). RESULTS Logistic regression indicated that negative cubic variation rates (NCV) predicted re-hospitalization. PFTW was found only marginally significant. CONCLUSION Variations in weight restoration during inpatient treatment may be used to identify patients at risk for relapse. NCV can alert clinicians to initiate early relapse prevention interventions before discharge. Level of Evidence Level III, cohort study.
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8
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De Cuyper K, Hermans D, Pieters G, Claes L, Vansteelandt K. Indirect and direct measures of striving for perfection moderate body mass index curves in the intensive treatment of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 27:86-96. [PMID: 30009415 DOI: 10.1002/erv.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/11/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Kathleen De Cuyper
- University Psychiatric Center KU Leuven, Leuven, Belgium.,KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Dirk Hermans
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Guido Pieters
- KU Leuven Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Laurence Claes
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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9
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Jennings KM, Gregas M, Wolfe B. Trajectories of Change in Body Weight During Inpatient Treatment for Anorexia Nervosa. J Am Psychiatr Nurses Assoc 2018; 24:306-313. [PMID: 28817991 PMCID: PMC5794613 DOI: 10.1177/1078390317726142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Identifying distinct trajectories of change in body weight during inpatient treatment for anorexia nervosa (AN) may provide knowledge about the process of weight restoration and may help detect optimal body weight response patterns among individuals who are at risk for not achieving weight restoration or leaving treatment prematurely. OBJECTIVE This study explored the extent to which distinct trajectories of change in body weight existed among individuals during inpatient treatment for AN. DESIGN Group-based trajectory modeling was used to identify distinct trajectories of change in body weight among 500 individuals receiving inpatient treatment for AN. RESULTS Four distinct trajectories were identified: weight gain ( n = 197), treatment resistant ( n = 177), weight plateau ( n = 82), and weight fluctuate ( n = 44). CONCLUSION Clinically, it is important to consider the heterogeneity of changes in body weight during inpatient treatment to help guide interventions and outcomes.
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Affiliation(s)
- Karen M Jennings
- 1 Karen M. Jennings, PhD, RN, PMHNP-BC, University of Chicago, Chicago, IL, USA
| | - Matthew Gregas
- 2 Matthew Gregas, PhD, Boston College, Chestnut Hill, MA, USA
| | - Barbara Wolfe
- 3 Barbara Wolfe, PhD, RN, FAAN, University of Rhode Island, Kingston, RI, USA
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10
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Makhzoumi SH, Coughlin JW, Schreyer CC, Redgrave GW, Pitts SC, Guarda AS. Weight gain trajectories in hospital-based treatment of anorexia nervosa. Int J Eat Disord 2017; 50:266-274. [PMID: 28186654 DOI: 10.1002/eat.22679] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/30/2023]
Abstract
Weight gain is a primary treatment goal for anorexia nervosa (AN); however little is known about heterogeneity in weight gain pattern during treatment. Preliminary evidence suggests weight gain trajectory is associated with treatment outcome. This study grouped patients using mixture modeling into weight gain trajectories, and compared predictors and treatment outcomes between trajectory groups. Women diagnosed with AN or subthreshold AN (N = 211) completed self-report measures at admission and six-months after discharge from an integrated inpatient (IP)-partial hospitalization (PH) behavioral specialty eating disorders program. Gowned weights were measured daily. Three distinct trajectories emerged: negative quadratic (Optimal), negative quadratic with fast weight gain (Fast), and positive linear with slower weight gain (Slow). The majority of patients were assigned to the Optimal group. Trajectory groups differed on admission, discharge, and follow-up variables. The Fast group emerged as most distinct. Women in this group were more than twice as likely to binge and or vomit regularly compared with the other two groups and were most likely to achieve weight restoration by discharge and to have more positive weight outcomes at short-term follow-up. There were no group differences in eating disorder behavioral frequencies at follow-up when adjusting for behavioral severity at admission. Weight gain trajectory may serve as a personalized in-treatment marker of outcome and could inform research on moderators and mediators of treatment response. Randomized controlled treatment studies, utilizing weight gain trajectories to determine group membership, may help identify subgroups of patients with differential responses to treatment interventions.
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Affiliation(s)
- Saniha H Makhzoumi
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven C Pitts
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Boehm I, Finke B, Tam FI, Fittig E, Scholz M, Gantchev K, Roessner V, Ehrlich S. Effects of perceptual body image distortion and early weight gain on long-term outcome of adolescent anorexia nervosa. Eur Child Adolesc Psychiatry 2016; 25:1319-1326. [PMID: 27154049 DOI: 10.1007/s00787-016-0854-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 04/18/2016] [Indexed: 11/29/2022]
Abstract
Anorexia nervosa (AN), a severe mental disorder with an onset during adolescence, has been found to be difficult to treat. Identifying variables that predict long-term outcome may help to develop better treatment strategies. Since body image distortion and weight gain are central elements of diagnosis and treatment of AN, the current study investigated perceptual body image distortion, defined as the accuracy of evaluating one's own perceived body size in relation to the actual body size, as well as total and early weight gain during inpatient treatment as predictors for long-term outcome in a sample of 76 female adolescent AN patients. Long-term outcome was defined by physical, psychological and psychosocial adjustment using the Morgan-Russell outcome assessment schedule as well as by the mere physical outcome consisting of menses and/or BMI approximately 3 years after treatment. Perceptual body image distortion and early weight gain predicted long-term outcome (explained variance 13.3 %), but not the physical outcome alone. This study provides first evidence for an association of perceptual body image distortion with long-term outcome of adolescent anorexia nervosa and underlines the importance of sufficient early weight gain.
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Affiliation(s)
- Ilka Boehm
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Beatrice Finke
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Friederike I Tam
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Eike Fittig
- Celenius Klinik Carolabad, Medical Rehabilitation Center for Psychotherapy, Psychiatry and Psychosomatic Medicine, Chemnitz, Germany
| | - Michael Scholz
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Krassimir Gantchev
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Eating Disorder Services and Research Center, Faculty of Medicine, Technische Universität Dresden, University Hospital C. G. Carus, Dresden, Germany.
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12
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Danielsen YS, Årdal Rekkedal G, Frostad S, Kessler U. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) in the treatment of anorexia nervosa: a prospective multidisciplinary study. BMC Psychiatry 2016; 16:342. [PMID: 27716162 PMCID: PMC5053175 DOI: 10.1186/s12888-016-1056-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/29/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a debilitating psychiatric disorder associated with a wide array of negative health complications and psychiatric comorbidity. Existing evidence for AN treatment in adults is weak, and no empirically supported treatment has been reliably established. The primary objective of this study is to gain knowledge about the effectiveness of enhanced cognitive behavioral therapy (CBT-E) for anorexia nervosa delivered in a public hospital setting. Baseline predictors of treatment outcome and dropout are studied. Furthermore, there will be collected blood and stool samples for a general biobank to be able to initiate research on possible pathophysiological mechanisms underlying AN. METHODS The study will assess the potency of outpatient CBT-E in a sample of patients suffering from AN (age >16) admitted to the Section for Eating Disorders at the Department for Psychosomatic Medicine, Haukeland University Hospital in Bergen, Norway. The study has a longitudinal design with five main assessment time points: before treatment, at 3 months, at the end of treatment, at 20 weeks, and at 12 months follow-up including biobank samples. A control group without an eating disorder will also be recruited. DISCUSSION Treatment research in a public hospital setting is important for gaining knowledge about the transportability of treatments evaluated in research clinics into ordinary clinical practice. Furthermore, biological material from the thoroughly described patient cohort will serve as a basis for further research on the pathophysiological mechanisms in AN. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02745067 . Registered 14 April 2016. .
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Affiliation(s)
- Yngvild S. Danielsen
- Department of Clinical Psychology, University of Bergen, Christiesgt.12, Po.box. 7800, 5021 Bergen, Norway
| | - Guro Årdal Rekkedal
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Stein Frostad
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
| | - Ute Kessler
- Division of Psychiatry, Haukeland University Hospital, Haukelandsveien.22, Po.box. 1400, 5021 Bergen, Norway
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13
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Linardon J, Brennan L, de la Piedad Garcia X. Rapid response to eating disorder treatment: A systematic review and meta-analysis. Int J Eat Disord 2016; 49:905-919. [PMID: 27528478 DOI: 10.1002/eat.22595] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This review aimed to (a) examine the effects of rapid response on behavioral, cognitive, and weight-gain outcomes across the eating disorders, (b) determine whether diagnosis, treatment modality, the type of rapid response (changes in disordered eating cognitions or behaviors), or the type of behavioral outcome moderated this effect, and (c) identify factors that predict a rapid response. METHOD Thirty-four articles met inclusion criteria from six databases. End of treatment and follow-up outcomes were divided into three categories: Behavioral (binge eating/purging), cognitive (EDE global scores), and weight gain. Average weighted effect sizes(r) were calculated. RESULTS Rapid response strongly predicted better end of treatment and follow-up cognitive and behavioral outcomes. Moderator analyses showed that the effect size for rapid response on behavioral outcomes was larger when studies included both binge eating and purging (as opposed to just binge eating) as a behavioral outcome. Diagnosis, treatment modality, and the type of rapid response experienced did not moderate the relationship between early response and outcome. The evidence for weight gain was mixed. None of the baseline variables analyzed (eating disorder psychopathology, demographics, BMI, and depression scores) predicted a rapid response. DISCUSSION As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc. Int J Eat Disord 2016; 49:905-919.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia.
| | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia
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Halvorsen I, Tollefsen H, Rø Ø. Rates of weight gain during specialised inpatient treatment for anorexia nervosa. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21662630.2016.1138413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 319] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Sly R, Mountford VA, Morgan JF, Lacey JH. Premature termination of treatment for anorexia nervosa: differences between patient-initiated and staff-initiated discharge. Int J Eat Disord 2014; 47:40-6. [PMID: 24323526 DOI: 10.1002/eat.22190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate treatment drop-out by comparing clinical indicators of patients whose discharge was initiated by staff with those who initiated discharge themselves. METHOD Ninety participants with anorexia completed questionnaires at admission and four weeks into hospitalized treatment. Weight data was collected over this same period. At discharge, participants were categorized into completer (n = 38) or patient-initiated (n = 36) /staff-initiated (n = 16) premature termination groups. RESULTS Significant differences between staff-initiated and patient-initiated discharge groups were found at admission. Staff initiated groups were on average older (p = .035), and more likely to have had prior compelled treatment (p = .039). At 4 weeks those in the patient-initiated group had put on weight at a faster rate (p = .032) and reported a decrease in alliance (p = .017). At discharge, staff initiated discharge demonstrated greater time in treatment (p = .001), greater weight gain (p = .027), and a higher discharge BMI (p = .013). At discharge, staff-initiated drop-outs had comparable end-of-treatment outcomes to those who completed treatment as planned. DISCUSSION There are key differences between those who prematurely discharge themselves from treatment, compared to those who are prematurely discharged by clinical staff. Future research into drop-out needs to take into account and recognize these differences.
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Affiliation(s)
- Richard Sly
- School of Nursing Sciences, University of East Anglia, Norwich, United Kingdom, NR7 4TJ; Eating Disorders Research Team, St George's, University of London, London, United Kingdom, SW17 0RE
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Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric disorder with high mortality rates a poor outcome and no empirically supported treatment of choice for adults. Weight increase is essential for recovery from AN why research exploring important contributors is crucial. AIMS The current study examined the importance of motivation to change eating behaviour, treatment expectations and experiences, eating disorder symptomatology, self-image and treatment alliance for predicting weight increase. METHODS Female patients (n = 89) between 18 and 46 years of age with AN were assessed pre-treatment and at 6- and 36-month follow-ups with interviews and self-report questionnaires. At the 6-month follow-up the response rates differed from n = 58 (65%) to 66 (74%), and at the 36-month follow-up the response rates differed from n = 71 (80%) to 82 (92%). RESULTS At treatment start, expressed motivation to change eating habits, social insecurity and self-neglect were predictors of weight increase from 0 to 6 months, while duration, the time from onset to entering treatment, body dissatisfaction and interoceptive awareness were predictors of weight increase from 0 to 36 months. CONCLUSIONS In designing treatment for adult patients with AN, it is essential to include multifaceted interventions addressed to patients' motivation to change, social relations, negative self-image and body dissatisfaction in order to achieve weight increase. Early detection and thereby short duration is an additional important factor that contributes to weight increase.
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Abbate-Daga G, Amianto F, Delsedime N, De-Bacco C, Fassino S. Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 2013; 13:294. [PMID: 24199620 PMCID: PMC3879222 DOI: 10.1186/1471-244x-13-294] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/25/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current literature on Eating Disorders (EDs) is devoid of evidence-based findings providing support to effective treatments, mostly for anorexia nervosa (AN). This lack of successful guidelines may play a role in making these disorders even more resistant. In fact, many individuals do not respond to the available treatments and develop an enduring and disabling illness. With this overview we aimed to highlight and discuss treatment resistance in AN--with an in-depth investigation of resistance-related psychological factors.A literature search was conducted on PubMed and PsychINFO; English-language articles published between 1990 and 2013 investigating the phenomenon of resistance to treatment in AN have been considered. DISCUSSION The selected papers have been then grouped into four main thematic areas: denial of illness; motivation to change; maintaining factors and treatment outcome; and therapeutic relationship. Eating symptomatology was found to only partially explain resistance to treatment. The role of duration of illness has been questioned whilst some maintaining factors seemed promising in providing a useful framework for this phenomenon. Emotive and relational aspects have been investigated on their role in resistance as well as therapists' countertransference. SUMMARY Remarkably there has been little research done on resistance to treatment in the ED field, in spite of its clinical relevance. Motivation, insight and subjective meaning of the illness can be useful tools to manage the resistance phenomenon when coupled with a wider approach. The latter enables the therapists to be aware of their role in the therapeutic alliance through countertransference aspects and to consider the EDs as disorders of the development of both personality and self, entailing severe impairments as regards identity and relationships.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Sly R, Morgan JF, Mountford VA, Lacey JH. Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eat Behav 2013; 14:119-23. [PMID: 23557806 DOI: 10.1016/j.eatbeh.2013.01.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/18/2012] [Accepted: 01/30/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to investigate treatment drop-out, and the associated roles of motivation, alliance, and behaviour change exhibited over the first four weeks of hospitalised treatment for anorexia. METHODS 90 participants meeting DSM-IV criteria for anorexia nervosa completed questionnaires at admission, and four weeks into treatment. Weight data was collected over this same time period. At the end of treatment, participants were categorised into completer or premature termination groups. RESULTS The overall rate of premature termination was 57.8%. Those who prematurely terminated treatment demonstrated lower discharge BMI (p<.0005), and weight gain (p<.0005) than those who completed. Therapeutic alliance proved significantly different between outcome groups at admission (p=.004). DISCUSSION End-of-treatment outcomes for those who do not complete treatment are invariably poor. Therapeutic alliance appears to be a particularly important factor in this area.
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Affiliation(s)
- Richard Sly
- Population Health Sciences and Education, St. George's University of London, London, UK.
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Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors. J Nerv Ment Dis 2012; 200:807-13. [PMID: 22922238 DOI: 10.1097/nmd.0b013e318266bbba] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
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Abstract
This study investigated changes and predictors during inpatient treatment of 55 adult in a transdiagnostic sample of patients with eating disorders. Patients were assessed at admission and discharge with the Body Attitude Test (BAT), Symptom Check List 90 Revised, Circumplex of Interpersonal Problems, Body Mass Index (BMI) and Eating Disorder Inventory 2 (EDI-2). Significant changes were found in all measures. Regression analyses showed that BAT changes during treatment were the strongest predictor of EDI-2 changes. No predictors of changes in BMI were found. Improvement of body image is important for the efficacy of inpatient treatment.
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Affiliation(s)
- Marit Danielsen
- Specialised Unit for Eating Disorder Patients, Department of Psychiatry, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway.
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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.
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Affiliation(s)
- Susan Hart
- Accredited Practising Dietitian, Department of Obstetrics and Gynaecology, University of Sydney, Royal North Shore Hospital, Australia.
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Sly R, Bamford B. Why are we waiting? The relationship between low admission weight and end of treatment weight outcomes. EUROPEAN EATING DISORDERS REVIEW 2010; 19:407-10. [PMID: 24081716 DOI: 10.1002/erv.1061] [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: 11/08/2022]
Abstract
Inpatient eating disorder units are increasingly being asked to admit patients at lower BMI's, often delaying hospital treatment until medically unavoidable. This paper aims to explore the impact of this trend on treatment outcome. Eighty-two adults with anorexia nervosa admitted to a national inpatient eating disorder ward were assessed for BMI at admission, length of hospitalisation, discharge BMI and re-admission within 1-year post-treatment. In the current study, admission BMI was unrelated to amount of weight gain during treatment or to length of hospital stay. As such patients admitted at lower BMI's had significantly lower BMI's on discharge from treatment. Low admission BMI's were related to significantly higher likelihoods of re-admission within 1 year. This study provides strong evidence for the benefit of early treatment episodes and with more successful treatment outcomes being related to higher weights at start of treatment.
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Affiliation(s)
- Richard Sly
- Department of Mental Health, St. Georges, University of London, London; South-West London and St. Georges NHS Trust, London.
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Vansteelandt K, Pieters G, Vanderlinden J, Probst M. Body dissatisfaction moderates weight curves in the inpatient treatment of Anorexia Nervosa. Int J Eat Disord 2010; 43:694-700. [PMID: 19816861 DOI: 10.1002/eat.20763] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether drive for thinness, body dissatisfaction, and restrictive/binge eating-purging subtype at admission moderates the weight curves of patients with Anorexia Nervosa (AN) over the course of inpatient treatment. METHOD The nature of weight curves, individual differences herein and moderating factors are examined in 92 AN patients by means of multilevel modeling. RESULTS The average weight curve of AN patients is characterized by a linear weight increase during treatment that levels off near the end of treatment. Substantial individual differences exist in the shape of patients' weight curves. Patients with stronger body dissatisfaction at admission display a slower linear rate of weight gain over the course of treatment. Neither drive for thinness nor restrictive/binge eating-purging subtype predicted patients' weight curve over the course of treatment. DISCUSSION Body dissatisfaction moderates patients' weight curves over the course of inpatient treatment but more research on factors determining weight curves is needed.
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Affiliation(s)
- Kristof Vansteelandt
- University Psychiatric Center Katholieke Universiteit Leuven--Campus Kortenberg, Katholieke Universiteit Leuven, Belgium.
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Sly R. What's in a name? Classifying ‘the dropout’ from treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2009; 17:405-7. [DOI: 10.1002/erv.964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Selection of the most powerful predictors for the evaluation of hepatic steatosis grade: An experimental study. Eur J Radiol 2009; 72:118-24. [DOI: 10.1016/j.ejrad.2008.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 05/15/2008] [Accepted: 06/12/2008] [Indexed: 01/22/2023]
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