1
|
Rienecke RD, Mehler PS, Duffy A, Le Grange D, Blalock DV. A brief examination of treatment outcomes in higher levels of care for individuals with eating disorders across age groups. EUROPEAN EATING DISORDERS REVIEW 2024; 32:431-439. [PMID: 38013216 DOI: 10.1002/erv.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Although eating disorders (EDs) occur throughout the lifespan, little research has been conducted with midlife/older adults, particularly those in higher levels of care (HLOC). The current study examined outcomes among 2009 patients with EDs receiving HLOC treatment at a large multisite facility between January 2020 and June 2022, across different age groups (ages <18, 18-25, 26-39 and ≥40). It was hypothesised that patients aged 40+ would exhibit less improvement on measures of ED psychopathology and depression than other age groups. METHOD Participants completed the eating disorder examination-questionnaire (EDE-Q) and the patient health questionnaire-9 (PHQ-9) at admission and discharge. RESULTS Changes for all outcomes from admission to discharge were statistically significant at p < 0.001 across all age groups. Changes in the EDE-Q Restraint subscale were significantly less in patients ages 26-39 than in patients ages 18-25 (p < 0.01). Changes in PHQ-9 were significantly greater in patients ages 40+ than patients ages 18-25 (p = 0.03). CONCLUSIONS Contrary to hypotheses, patients ages 40+ did not show worse outcomes than younger patients, and showed greater improvements in depression than young adults. The therapeutic needs of midlife/older adults with EDs may be favourably met by a HLOC regimen as described in this study.
Collapse
Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- ACUTE at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
2
|
de Boer K, Johnson C, Wade TD, Radunz M, Fernando AN, Babb J, Stafrace S, Sharp G. A systematic review and meta-analysis of intensive treatment options for adults with eating disorders. Clin Psychol Rev 2023; 106:102354. [PMID: 37926059 DOI: 10.1016/j.cpr.2023.102354] [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: 06/30/2023] [Revised: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Eating disorders (EDs) are complex conditions with one of the highest mortality rates among psychiatric illnesses. While outpatient evidence-based treatments for EDs in adults exist, there is often utilisation of more intensive interventions as part of treatment. However, a comprehensive analysis of the impacts of intensive treatment (inpatient, residential and day program) on physical and psychosocial outcomes is lacking. Thus, the current systematic review and meta-analysis aimed to investigate the effectiveness of intensive treatments in adults with EDs for the outcomes of body mass index (BMI), disordered eating, depression, and quality of life, as well as a moderation analysis investigating a range of clinical characteristics. Overall, 62 studies were included in the meta-analysis. The results revealed that intensive treatment in adults yielded significant improvements in BMI (for underweight patients), disordered eating, depression, and quality of life. Treatment setting, length of stay and geographical region of the study all served as moderators for disordered eating and depression. Nevertheless, given the high heterogeneity in the meta- and moderation analyses, these results should be interpreted with caution. Future high-quality research is needed to determine the most beneficial elements of intensive treatment (compared to outpatient) in adults with EDs.
Collapse
Affiliation(s)
- Kathleen de Boer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Catherine Johnson
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Marcela Radunz
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Jennifer Babb
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Simon Stafrace
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia.
| |
Collapse
|
3
|
Litmanovich-Cohen L, Yaroslavsky A, Halevy-Yosef LR, Shilton T, Enoch-Levy A, Stein D. Post-hospitalization Daycare Treatment for Adolescents With Eating Disorders. Front Psychiatry 2021; 12:648842. [PMID: 34135782 PMCID: PMC8200532 DOI: 10.3389/fpsyt.2021.648842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There are several possible facilities for the treatment of eating disorders (EDs). Specifically, there is the issue of the use of specialized daycare and ambulatory services over inpatient settings and the place of daycare programs following inpatient treatment. Aim: We sought to examine the contribution of post-hospitalization daycare program to the treatment of adolescents hospitalized with an ED. Methods: We assessed 61 female adolescents hospitalized with an ED. All but three were diagnosed with clinical or subthreshold anorexia nervosa (AN). Three were diagnosed with bulimia nervosa. Thirty-seven patients continued with a post-hospitalization daycare program for at least 5 months, whereas 24 did not enter or were enrolled in the program for <5 months. Patients completed on admission to, and discharge from, inpatient treatment self-rating questionnaires assessing ED-related symptoms, body-related attitudes and behaviors, and depression and anxiety. Social functioning was assessed 1 year from discharge using open-ended questions. One-year ED outcome was evaluated according to the patients' body mass index (BMI) and according to composite remission criteria, assessed with a standardized semistructured interview. To be remitted from an ED, patients were required to maintain a stable weight, to have regular menstrual cycles, and not to engage in binging, purging, and restricting behaviors for at least eight consecutive weeks before their assessment. Results: BMI was within normal range at follow-up, whether completing or not completing daycare treatment, and around 75% of the patients had menstrual cycles. By contrast, when using comprehensive composite remission criteria, less than a quarter of former inpatients not entering/not completing daycare program achieved remission vs. almost a half of the completers. In addition, a greater percentage of completers continued with psychotherapy following discharge. Fifty percent of both groups showed good post-discharge social functioning. No between-group differences were found in the BMI and the scores of the self-rating questionnaires at admission to, and discharge from, inpatient treatment. Conclusion: Adolescent females with EDs can maintain a normal-range BMI from discharge to 1-year follow-up, even if not completing daycare treatment. By contrast, completion of a post-hospitalization daycare program may improve the 1-year follow-up ED-related outcome of former ED inpatients.
Collapse
Affiliation(s)
- Liron Litmanovich-Cohen
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Hadarim Eating Disorders Outpatient Service, Shalvata Mental Health Center, Hod Hsaharon, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Liron Roni Halevy-Yosef
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Shilton
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sacker Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Combining day treatment and outpatient treatment for eating disorders: findings from a naturalistic setting. Eat Weight Disord 2020; 25:519-530. [PMID: 30706362 DOI: 10.1007/s40519-019-00643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. PURPOSE We investigated the long-term effectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. METHODS We accepted 148 patients with different diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. RESULTS Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients significantly improved with large effect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. CONCLUSIONS Our findings add to the existing studies on day treatment and support previously found encouraging effects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
Collapse
|
5
|
Matthews K, Gordon L, van Beusekom J, Sheffield J, Patterson S. A day treatment program for adults with eating disorders: staff and patient experiences in implementation. J Eat Disord 2019; 7:21. [PMID: 31304014 PMCID: PMC6600879 DOI: 10.1186/s40337-019-0252-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eating disorders are serious conditions which are increasing in prevalence internationally. The causes of these conditions are complex and incompletely understood, and clinical presentations can vary over time. The complexity of these conditions can also complicate treatment. Therefore, stepped care treatment comprising a hierarchy of interventions, including access to day treatment programs (DTPs), is recommended. While studies have examined patient outcomes and provided narrative accounts of these programs, no published studies describe DTP development. This study aims to address this gap by examining development and implementation of a DTP from service providers and patients' perspectives. METHODS This study utilised a mixed-methods design to examine the design and implementation of a publicly funded, closed group DTP in Australia. Data from service records and documents were analysed, alongside interviews with patients and interview and focus groups with service providers conducted between June 2016 and July 2017. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using the Framework Approach. RESULTS Seventeen service providers (n = 4 in managerial and n = 13 clinical positions, with clinical experience of 3 months to 20 years) and 11 patients (100% F, 17-33 years) were interviewed. The service providers reported that implementation was a stressful undertaking due to tight timeframes to achieve multiple tasks. Patients had diverse opinions regarding the DTP content and the group treatment experience. Despite this, all patients reported benefits from attending the DTP, varying from improvements in mood, weight gain, development of personal skills and strengths, to living independently. For further benefit, patients suggested that programs could be shaped and targets towards differing patient groups, with fewer breaks throughout treatment. CONCLUSIONS Designing and implementing a DTP is a challenge and can be a time-intensive undertaking, however the result can be beneficial for both service providers and patients. The closed group format was beneficial in creating a supportive environment, though may have led to increases in additional eating disordered behaviours. While the current structure of this DTP may require reconsideration, organisations considering implementing a new DTP may find usefulness in the overall design described in this study, alongside learning from the issues experienced.
Collapse
Affiliation(s)
- Kylie Matthews
- 1Royal Brisbane and Women's Hospital, Nutrition and Dietetics, Level 2 James Mayne Building, RBWH, Herston, 4006 Australia
| | - Leanne Gordon
- 2Psychology, University of Queensland, St Lucia, 4067 Australia
| | | | | | | | - Susan Patterson
- Royal Brisbane and Women's Hopsital, Mental Health Centre, J Floor, Herston, 4006 Australia
| |
Collapse
|
6
|
Denison-Day J, Appleton KM, Newell C, Muir S. Improving motivation to change amongst individuals with eating disorders: A systematic review. Int J Eat Disord 2018; 51:1033-1050. [PMID: 30189116 DOI: 10.1002/eat.22945] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE People with eating disorders can have low motivation to change their eating disorder behaviors. Interventions aiming to enhance motivation to change have been increasingly advocated in their treatment. Questions remain regarding the strength of the evidence supporting the effectiveness of interventions that specifically focus on improving motivation. This review explored the evidence for improving motivation to change in eating disorders via clinical interventions. METHOD Searches of the published and unpublished literature were conducted by searching databases (PubMed, PsychInfo, Web of Science) and trial registries (WHO ICTRP), and by contacting authors. Studies were included if they investigated an intervention for eating disorder patients, included a pre-post outcome measure of motivation to change and were published in English. Risk of bias was also assessed. RESULTS Forty-two studies were included in the final review. Evidence was found to support the use of interventions to improve motivation to change, though it was unclear whether motivational interventions present a more effective option than approaches that do not exclusively or specifically focus on motivation. However, motivational interventions were identified as being more effective than low intensity treatments. Risk of bias in included studies was generally high. DISCUSSION Motivation was found to increase across treatments in general, whether or not the focus of the intervention was on enhancing motivation. It is unclear if interventions specifically targeting motivation to change provide additional benefit over and above established treatment approaches.
Collapse
Affiliation(s)
- James Denison-Day
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
| | - Katherine M Appleton
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
| | - Ciarán Newell
- Dorset Healthcare University NHS Foundation Trust, Poole, United Kingdom
| | - Sarah Muir
- Bournemouth University, Department of Psychology, Research Center for Behavior Change, Bournemouth, United Kingdom
| |
Collapse
|
7
|
Brown TA, Cusack A, Anderson LK, Trim J, Nakamura T, Trunko ME, Kaye WH. Efficacy of a partial hospital programme for adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018. [DOI: 10.1002/erv.2589] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tiffany A. Brown
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Anne Cusack
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Leslie K. Anderson
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Julie Trim
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Tiffany Nakamura
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Mary Ellen Trunko
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| |
Collapse
|
8
|
Zeeck A, Herpertz-Dahlmann B, Friederich HC, Brockmeyer T, Resmark G, Hagenah U, Ehrlich S, Cuntz U, Zipfel S, Hartmann A. Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis. Front Psychiatry 2018; 9:158. [PMID: 29765338 PMCID: PMC5939188 DOI: 10.3389/fpsyt.2018.00158] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults). Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included. Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment. Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge.
Collapse
Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Friederich
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrich Hagenah
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrich Cuntz
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
| | - Stephan Zipfel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
9
|
Wade T, Vall E, Kuek A, Altman E, Long R, Mannion J. Development of a new statewide eating disorder service: The role of evidence in a real world setting. Int J Eat Disord 2017; 50:293-301. [PMID: 28122125 DOI: 10.1002/eat.22664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There are three aims of this report. First, to describe how research evidence informed a service development rationale for a new statewide eating disorder service (SEDS) for people aged 15 years and older. Second, to examine the profile of people accessing SEDS in the first 2 years of its operation with respect to the three broad dimensions: illness stage, illness severity, and previous history of treatment. Finally, to examine which patient characteristics resulted in the recommendation of ongoing treatment contact with SEDS. METHOD Over a 2-year period (July 2014 to July 2016) 292 people were referred to the service, 171 (59%) who consented to have their data used in research. RESULTS Half of the referrals related to anorexia nervosa (AN; 51.2%), with the remainder split between bulimia nervosa (25.3%) and other specified feeding and eating disorders (23.5%); 65.9% had previously received treatment for an eating disorder. The initial information about the service was typically provided by the general practitioner/primary care physician. Compared with any other eating disorder diagnosis, people with AN were three times more likely to be recommended to retain treatment contact with SEDS. DISCUSSION Service development informed by research evidence, clinical expertise, and consideration of patients' characteristics, values, and circumstances, allows for a flexible but accountable development strategy.
Collapse
Affiliation(s)
- Tracey Wade
- School of Psychology, Flinders University, Adelaide, Australia
| | - Eva Vall
- School of Psychology, Flinders University, Adelaide, Australia
| | - Angeline Kuek
- Statewide Eating Disorder Service, South Australia, Australia
| | - Emma Altman
- Statewide Eating Disorder Service, South Australia, Australia
| | - Randall Long
- Statewide Eating Disorder Service, South Australia, Australia
| | - John Mannion
- Mental Health Services, Southern Adelaide Local Health Network, Australia
| |
Collapse
|
10
|
Friedman K, Ramirez AL, Murray SB, Anderson LK, Cusack A, Boutelle KN, Kaye WH. A Narrative Review of Outcome Studies for Residential and Partial Hospital-based Treatment of Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2016; 24:263-76. [PMID: 27062687 DOI: 10.1002/erv.2449] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/23/2016] [Accepted: 03/05/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to review the current eating disorders outcome literature after residential or partial hospitalization programme (PHP) treatment. METHOD Articles were identified through a systematic search of PubMed and PsycINFO. RESULTS Twenty-two PHP and six residential treatment studies reported response at discharge and tended to find improvement. Fewer studies (nine PHP and three residential) reported outcome at some interval after discharge from treatment. These tended to find sustained improvement. A substantial proportion of patients were lost to follow-up, particularly for residential treatment. Only two follow-up studies used controlled trials; both showed efficacy for PHP compared with inpatient treatment with regard to maintaining symptom remission. CONCLUSIONS Improvement at discharge may not predict long-term outcome. Long-term follow-up studies were confounded by high dropout rates. While higher levels of care may be essential for reversing malnutrition, there remains a lack of controlled trials showing long-term efficacy, particularly for residential treatment settings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
| | - Ana L Ramirez
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Diego, CA, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Kerri N Boutelle
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
| |
Collapse
|
11
|
Green J, Melvin GA, Newman L, Jones M, Taffe J, Gordon M. Day program for young people with anorexia nervosa. Australas Psychiatry 2015; 23:249-53. [PMID: 25948510 DOI: 10.1177/1039856215584513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study examined changes in body mass index (BMI), anorectic cognitions, and psychological distress following day program treatment. METHODS Participants were 42 female patients from the Monash Health Butterfly eating disorder day program, with anorexia nervosa (AN) restricting type (n = 35) or AN binge-eating/purging type (n = 7), ranging from 12 to 24 years. RESULTS Participants' BMI increased significantly over time. Higher motivation at intake predicted a greater increase in BMI over time, compared to those with lower motivation at intake. There were also significant reductions in drive for thinness, body dissatisfaction, anxiety, and depression scores, and improved motivation following two, four and six months of treatment. CONCLUSIONS These findings provide further evidence that day programs can assist in weight restoration and improvements in psychological aspects of AN in adolescents and young adults.
Collapse
Affiliation(s)
- Jessica Green
- Director of Psychology (Clinical) Candidate, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Glenn A Melvin
- Senior Lecturer and Clinical Psychologist, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Louise Newman
- Director, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Meaghan Jones
- Clinical Psychologist, Monash Health Early in Life Mental Health Service, Monash Health Victoria, Clayton, VIC, Australia
| | - John Taffe
- Biostatistician, Centre for Developmental Psychiatry & Psychology, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Gordon
- Unit Head, Child and Adolescent Stream, Early in Life Mental Health Service, Monash Health Victoria, Clayton, VIC, Australia
| |
Collapse
|
12
|
Madden S, Hay P, Touyz S. Systematic review of evidence for different treatment settings in anorexia nervosa. World J Psychiatry 2015; 5:147-153. [PMID: 25815264 PMCID: PMC4369544 DOI: 10.5498/wjp.v5.i1.147] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/28/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient.
METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms “anorexia nervosa” and “treatment” dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition.
RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care.
CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.
Collapse
|
13
|
Ackard DM, Cronemeyer CL, Richter S, Egan A. Do symptom-specific stages of change predict eating disorder treatment outcome? Eat Weight Disord 2015; 20:49-62. [PMID: 25249403 DOI: 10.1007/s40519-014-0153-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Interview methods to assess stages of change (SOC) in eating disorders (ED) indicate that SOC are positively correlated with symptom improvement over time. However, interviews require significant time and staff training and global measures of SOC do not capture varying levels of motivation across ED symptoms. This study used a self-report, ED symptom-specific SOC measure to determine prevalence of stages across symptoms and identify if SOC predict treatment outcome. METHODS Participants [N = 182; age 13-58 years; 92% Caucasian; 96% female; average BMI 21.7 (SD = 5.9); 50% ED not otherwise specified (EDNOS), 30.8% bulimia nervosa (BN), 19.2% anorexia nervosa (AN)] seeking ED treatment at a diverse-milieu multi-disciplinary facility in the United States completed stages of change, behavioral (ED symptom use and frequency) and psychological (ED concerns, anxiety, depression) measures at intake assessment and at 3, 6 and 12 months thereafter. Descriptive summaries were generated using ANOVA or Kruskal-Wallis (continuous) and χ (2) (categorical) tests. Repeated measures linear regression models with autoregressive correlation structure predicted treatment outcome. RESULTS At intake assessment, 53.3% of AN, 34.0% of BN and 18.1% of EDNOS patients were in Preparation/Action. Readiness to change specific symptoms was highest for binge-eating (57.8%) and vomiting (56.5%). Frequency of fasting and restricting behaviors, and scores on all eating disorder and psychological measures improved over time regardless of SOC at intake assessment. Symptom-specific SOC did not predict reductions in ED symptom frequency. Overall SOC predicted neither improvement in Eating Disorder Examination Questionnaire (EDE-Q) scores nor reduction in depression or trait anxiety; however, higher overall SOC predicted lower state anxiety across follow-up. CONCLUSIONS Readiness to change ED behaviors varies considerably. Most patients reduced eating disorder behaviors and increased psychological functioning regardless of stages of change, indicating the benefits of treatment and effectiveness of treatment-as-usual for overall psychiatric improvement.
Collapse
Affiliation(s)
- Diann M Ackard
- , 5101 Olson Memorial Highway, Suite 4001, Golden Valley, MN, 55422, USA,
| | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric disease. Choice of acute inpatient care for AN is driven by the severity of symptoms and the level of risk to the patient. Inpatient hospitalization of patients with AN typically includes a behavioral weight gain protocol that is designed to address the core features of the disorder: weight, appetite, and distorted thoughts and behavior. Some add-on treatments may also be included in the inpatient treatment model and may have potential benefits, including faster or greater weight gain; such treatments include psychotherapy, psychoeducation, pharmacological treatment, and nutritional replacement. OBJECTIVE The goal of this study was to systematically review randomized clinical trials (RCTs) that have compared the efficacy of different forms of add-on treatment delivered during admission to a 24-hour hospital and to summarize the existing data regarding weight gain associated with such pharmacological, medical, and psychological interventions. METHODS Systematic electronic and manual searches were conducted to identify published RCTs concerning inpatient treatment of AN. Weight gain was used as the main outcome variable. RESULTS Overall, no significant increase in weight recovery was reported with atypical antipsychotics compared to placebo or therapy as usual. Only one study showed slight benefits in young patients during hospitalization (d=0.77; 95% confidence interval [CI] -0.09-1.64). No significant effects on weight recovery were found for antidepressants (d=-0.10; 95% CI=-0.63-0.42). In addition, none of the add-on psychotherapy techniques that were evaluated demonstrated superiority compared with control interventions in the inpatient setting. Cyclic enteral nutrition was studied in one RCT in which it demonstrated superiority compared to oral refeeding only (d=0.97; 95% CI=0.51-1.47). Other less common treatments such as bright light therapy and lithium carbonate were not found to produce additional significant weight improvement compared with placebo. CONCLUSION Most add-on treatments during the acute inpatient phase of AN treatment are not effective in increasing weight recovery. Long-term follow-up studies after the acute treatment phase are needed to make evidence-based recommendations.
Collapse
|
15
|
McFarlane T, MacDonald DE, Trottier K, Olmsted MP. The effectiveness of an individualized form of day hospital treatment. Eat Disord 2015; 23:191-205. [PMID: 25411716 DOI: 10.1080/10640266.2014.981430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The traditional group format of day hospital treatment for eating disorders restricts individual tailoring of treatment, which is challenging when complex cases are referred. In 2007 we introduced a new program that included individual sessions. Patients referred to this program were older, had longer illness duration, and more pre-treatment symptoms than the original group program. These clients also had more psychopathology, and were more likely to have a diagnosis of anorexia nervosa binge/purge subtype. Weight gain and abstinence from symptoms were less likely for patients in this new program. However, premature discharge, rapid response, symptom frequencies, and relapse rates did not differ.
Collapse
Affiliation(s)
- Traci McFarlane
- a Eating Disorder Program , University Health Network , Toronto , Ontario , Canada
| | | | | | | |
Collapse
|
16
|
Ben-Porath DD, Federici A, Wisniewski L, Warren M. Dialectical Behavior Therapy: Does It Bring About Improvements in Affect Regulation in Individuals with Eating Disorders? JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2014. [DOI: 10.1007/s10879-014-9271-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Goldstein M, Peters L, Thornton CE, Touyz SW. The Treatment of Perfectionism within the Eating Disorders: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2014; 22:217-21. [DOI: 10.1002/erv.2281] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Mandy Goldstein
- Centre for Emotional Health, Department of Psychology; Macquarie University; Sydney NSW Australia
- The Redleaf Practice; Sydney NSW Australia
| | - Lorna Peters
- Centre for Emotional Health, Department of Psychology; Macquarie University; Sydney NSW Australia
| | | | - Stephen W. Touyz
- Clinical Psychology Unit, Mackie Building (K01); The University of Sydney; NSW Australia
| |
Collapse
|
18
|
Henderson K, Buchholz A, Obeid N, Mossiere A, Maras D, Norris M, Harrison M, Feder S, Spettigue W. A family-based eating disorder day treatment program for youth: examining the clinical and statistical significance of short-term treatment outcomes. Eat Disord 2014; 22:1-18. [PMID: 24365524 DOI: 10.1080/10640266.2014.857512] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes an innovative family-based day treatment program (DTP) for youth with moderate to severe eating disorders. A sample of 65 youth completed a battery of psychological measures pre- and post-treatment and 6 months after program completion. Treatment outcomes were assessed in three main domains: (a) medical stabilization, (b) normalization of eating behavior, and (c) improved psychological functioning. Overall, patients demonstrated statistically significant and clinically meaningful improvements on all outcome measures. Findings indicate that a comprehensive DTP can successfully facilitate positive outcomes in youth with eating disorders and that these improvements can be maintained 6 months post-treatment.
Collapse
Affiliation(s)
- Katherine Henderson
- a Department of Psychology , Carleton University , Ottawa , Ontario , Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Olmsted MP, McFarlane T, Trottier K, Rockert W. Efficacy and intensity of day hospital treatment for eating disorders. Psychother Res 2013; 23:277-86. [DOI: 10.1080/10503307.2012.721937] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
20
|
The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Res 2012; 200:1-11. [PMID: 22717144 DOI: 10.1016/j.psychres.2012.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 11/22/2022]
Abstract
This review examines the effectiveness of interventions that include the principles and techniques of motivational interviewing (MI) and its adaptations in the treatment of eating disorders. The aims are (1) to examine both the context and effectiveness of MI and Motivational Enhancement Therapy (MET) when used with either patients or carers of people with eating disorders, (2) to identify limitations and/or difficulties in this process and (3) to identify further research needs in this area. Electronic databases were searched up until April 2012. Articles were screened according to predetermined inclusion and exclusion criteria. Thirteen studies were finally selected for inclusion. A wide range of participants, interventions and outcomes were measured which made comparative analysis difficult. Promising results were found for interventions that included MI, particularly with regards to its use in increasing a readiness and motivation to change. Consequently, there is potential for using MI in the field of eating disorders, particularly with respect to 'readiness for change'. More homogeneity in study design and delivery of MI is needed along with some markers of treatment fidelity, including information as to how adherence to the intervention is assured.
Collapse
|
21
|
Ornstein RM, Lane-Loney SE, Hollenbeak CS. Clinical outcomes of a novel, family-centered partial hospitalization program for young patients with eating disorders. Eat Weight Disord 2012; 17:e170-7. [PMID: 23086252 DOI: 10.1007/bf03325344] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM Eating disorders (ED) in children and younger adolescents are becoming more evident, but there is a small evidence base for their management in this population. We hypothesized that a new family-centered partial hospital program for young patients would be effective in promoting weight gain, as well as improvement in psychiatric symptoms. METHODS A retrospective chart review of 56 patients treated in the program between August 2008 and November 2009 was performed. Historical data, anthropometric variables and scores from psychological instruments [Children's Eating Attitudes Test (ChEAT), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS)] were collected on admission and at discharge. After exclusion, 30 patients were available for statistical analysis, using paired t-tests. The primary outcome variables were improvement in weight and change in total ChEAT score. Secondary outcomes included improvements in the CDI and RCMAS scores. Multivariate analysis included linear regression models that controlled for patient-specific fixed effects. RESULTS The cohort was 87% female with a mean age of 12.8±2 years; 60% were diagnosed with ED not otherwise specified. Two-thirds had a co-morbid depressive and/or anxiety disorder. Change in weight was significant (p<0.0001), as were improvements on total ChEAT (p<0.0001), CDI (p=0.0002), and RCMAS (p<0.0001) scores. No historical factors were correlated with improvement, nor was use of psychotropic medications. Length of stay in weeks significantly predicted greater weight gain (p=0.004, R2=0.26). CONCLUSIONS Patients treated in a family-centered partial hospital program had significant improvements in weight and psychological parameters. This approach holds significant promise for the management of young ED patients.
Collapse
Affiliation(s)
- R M Ornstein
- Department of Pediatrics, Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
| | | | | |
Collapse
|
22
|
Dray J, Wade TD. Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 2012; 32:558-65. [DOI: 10.1016/j.cpr.2012.06.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 06/12/2012] [Accepted: 06/25/2012] [Indexed: 11/24/2022]
|
23
|
Gale C, Gilbert P, Read N, Goss K. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother 2012; 21:1-12. [PMID: 22740105 DOI: 10.1002/cpp.1806] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. METHOD Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). RESULTS There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). CONCLUSION This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. KEY PRACTITIONER MESSAGE CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.
Collapse
Affiliation(s)
- Corinne Gale
- Mental Health Research Unit, Kingsway, Derby, UK
| | | | | | | |
Collapse
|
24
|
Crino N, Djokvucic I. Cohesion to the group and its association with attendance and early treatment response in an adult day-hospital program for eating disorders: A preliminary clinical investigation. CLIN PSYCHOL-UK 2010. [DOI: 10.1080/13284207.2010.500308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Natalie Crino
- Department of Medical Psychology, Westmead Hospital , Westmead, New South Wales, Australia
| | - Ivana Djokvucic
- Department of Medical Psychology, Westmead Hospital , Westmead, New South Wales, Australia
| |
Collapse
|