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İnce B, Phillips M, Schmidt U. Intensive community and home-based treatments for eating disorders: a scoping review study protocol. BMJ Open 2023; 13:e064243. [PMID: 36792335 PMCID: PMC9933757 DOI: 10.1136/bmjopen-2022-064243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes. METHODS This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy. ETHICS AND DISSEMINATION Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.
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Affiliation(s)
- Başak İnce
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Phillips
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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Irish M, Dalton B, Potts L, McCombie C, Shearer J, Au K, Kern N, Clark-Stone S, Connan F, Johnston AL, Lazarova S, Macdonald S, Newell C, Pathan T, Wales J, Cashmore R, Marshall S, Arcelus J, Robinson P, Himmerich H, Lawrence VC, Treasure J, Byford S, Landau S, Schmidt U. The clinical effectiveness and cost-effectiveness of a 'stepping into day treatment' approach versus inpatient treatment as usual for anorexia nervosa in adult specialist eating disorder services (DAISIES trial): a study protocol of a randomised controlled multi-centre open-label parallel group non-inferiority trial. Trials 2022; 23:500. [PMID: 35710394 PMCID: PMC9201798 DOI: 10.1186/s13063-022-06386-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Anorexia nervosa (AN) is a serious and disabling mental disorder with a high disease burden. In a proportion of cases, intensive hospital-based treatments, i.e. inpatient or day patient treatment, are required, with day patient treatment often being used as a ‘step-down’ treatment after a period of inpatient treatment. Demand for such treatment approaches has seen a sharp rise. Despite this, the relative merits of these approaches for patients, their families, and the NHS and wider society are relatively unknown. This paper describes the rationale for, and protocol of, a two-arm multi-centre open-label parallel group non-inferiority randomised controlled trial, evaluating the effectiveness and cost-effectiveness of these two intensive treatments for adults with severe AN: inpatient treatment as usual and a stepped care day patient approach (the combination of day patient treatment with the option of initial inpatient treatment for medical stabilisation). The main aim of this trial is to establish whether, in adults with severe AN, a stepped care day patient approach is non-inferior to inpatient treatment as usual in relation to improving body mass index (BMI) at 12 months post-randomisation. Methods 386 patients with a Diagnostic and Statistical Manual 5th edition diagnosis of severe AN or related disorder, with a BMI of ≤16 kg/m2 and in need of intensive treatment will be randomly allocated to either inpatient treatment as usual or a stepped care day patient approach. Patients in both groups will receive treatment until they reach a healthy weight or get as close to this point as possible. Assessments will be conducted at baseline (prior to randomisation), and at 6 and 12 months post-randomisation, with additional monthly symptom monitoring. The primary outcome will be BMI at the 12-month post-randomisation assessment. Other outcomes will include psychosocial adjustment; treatment motivation, expectations and experiences; cost-effectiveness; and carer burden. Discussion The results of this study will provide a rigorous evaluation of two intensive treatment approaches which will inform future national and international treatment guidelines and service provision. Trial registration ISRCTN ISRCTN10166784. Registered 28 February 2020. ISRCTN is a primary registry of the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) network and includes all items from the WHO Trial Registration Data Set.
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Affiliation(s)
- Madeleine Irish
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Laura Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Clark-Stone
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Frances Connan
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | | | - Ciarán Newell
- Dorset HealthCare University NHS Foundation Trust, Poole, UK
| | - Tayeem Pathan
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Jackie Wales
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Rebecca Cashmore
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Sandra Marshall
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK
| | - Paul Robinson
- Division of Medicine, University College London, 5 University Street, London, WC1E, 6JF, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Vanessa C Lawrence
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
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Marzola E, Longo P, Sardella F, Delsedime N, Abbate-Daga G. Rehospitalization and "Revolving Door" in Anorexia Nervosa: Are There Any Predictors of Time to Readmission? Front Psychiatry 2021; 12:694223. [PMID: 34366923 PMCID: PMC8342847 DOI: 10.3389/fpsyt.2021.694223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/08/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: Anorexia nervosa (AN) is a severe psychiatric illness with multifactorial etiology and unsatisfactory treatment outcomes. Hospitalization is required for a substantial number of patients, and readmission (RA) commonly occurs. Some individuals need multiple hospitalizations sometimes over a short amount of time, thus, delineating the "revolving door" (RD) phenomenon. However, very little is known about readmissions and their frequency in AN. Therefore, we aimed to longitudinally investigate readmissions in AN in order to: (a) characterize patients with AN who need readmission (i.e., RA-AN), sometimes rapidly (RD-AN); (b) ascertain differences between RA-AN and non-RA-AN groups during baseline hospitalization; (c) investigate as to whether clinical or psychometric parameters worsened on RA; and (d) analyze predictors of time-to-readmission in AN. Methods: A total of 170 inpatients with AN were enrolled at their baseline hospitalization; all their subsequent rehospitalizations were recorded with a longitudinal design by which each patient has been observed for 3 years. Patients were classified as RD-AN if requiring a readmission <12 months since last discharge. Clinical characteristics were measured upon admission and discharge for each hospitalization, and at all time points, patients completed questionnaires assessing eating and general psychopathology, and body shape concerns. Results: Sixty-seven patients (39.4%) needed at least one readmission and 62 (92.5% of RA-AN) reported RD. Compared with non-RA-AN, those with RA-AN were younger, reported a shorter duration of illness, and were more frequently diagnosed with AN-BP. Also, greater severity of anxious and depressive symptoms and body shape concerns emerged in the RA-AN group. The outcome of baseline hospitalization did not differ between groups, and only depressive symptoms worsened at readmission. Shorter duration of AN and low weight gain during baseline hospitalization predicted early readmission but did not survive statistical control. In contrast, high scores on drive for thinness upon baseline hospital entry robustly predicted a shorter time to readmission even after statistical control. Discussion: Individuals with AN who require readmission do so over a short period notwithstanding a positive treatment outcome during their baseline hospitalization. Shorter time-to-readmission can be predicted mostly in case of marked drive for thinness and poor weight gain at baseline hospital admission.
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Affiliation(s)
- Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Paola Longo
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Federica Sardella
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Nadia Delsedime
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
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Baudinet J, Simic M, Griffiths H, Donnelly C, Stewart C, Goddard E. Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord 2020; 8:68. [PMID: 33292696 PMCID: PMC7663904 DOI: 10.1186/s40337-020-00338-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. METHOD Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. RESULTS Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = -.67), reward responsivity (r = -.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. CONCLUSIONS This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Helena Griffiths
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Cecily Donnelly
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Elizabeth Goddard
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
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Wade TD, Eshkevari E, Guerin C, Smith J, Hoskin D. Examination of a day programme for eating disorders: impact on 3-month follow-up by psychiatric comorbidity. Australas Psychiatry 2020; 28:148-152. [PMID: 31526036 DOI: 10.1177/1039856219871873] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The two aims of this preliminary investigation were to use a case series design to examine outcomes of a day programme (DP) for eating disorders and to investigate whether the presence of baseline psychiatric comorbidities moderated outcomes 3 months after discharge. METHOD Linear mixed modelling was used to investigate changes over time in the 91 participants who had commenced the DP by April 2019; 87 (96%) female, 61 (67%) with a DSM-5 diagnosis of anorexia nervosa. RESULTS Six of our seven outcome variables (dietary restraint; concern over weight, eating and shape; clinical impairment; and psychological distress) showed moderate to large effect size improvements from baseline to follow-up. Generally, improvement declined somewhat at follow-up from discharge, with a pattern of results suggesting this decline was less where there was comorbidity at baseline. CONCLUSIONS These results suggest that a DP effectively reduces eating disorder psychopathology regardless of the presence of psychiatric comorbidity.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, SA, Australia.,Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Ertimiss Eshkevari
- Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Corree Guerin
- Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jasmine Smith
- Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia.,Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Daniela Hoskin
- Statewide Eating Disorder Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
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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.
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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.
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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
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Simic M, Stewart CS, Eisler I, Baudinet J, Hunt K, O'Brien J, McDermott B. Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder. Int J Eat Disord 2018; 51:1261-1269. [PMID: 30265750 DOI: 10.1002/eat.22959] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family Therapy for Anorexia Nervosa (FT-AN) is the first line treatment for adolescents with anorexia nervosa in the UK. However, research suggests between 10 and 40% of young people have a poor outcome. For those for whom FT-AN alone is not effective there is a clear need to develop additional treatments. This paper describes the effectiveness of an additional treatment for adolescents who had not responded to FT-AN, the Intensive Day Treatment Program (ITP) embedded within a comprehensive outpatient service at the Maudsley Hospital. METHOD Data from a retrospective chart review of patient files were analyzed for 105 young people aged 11-18 with restrictive eating disorders referred to the program in the first four and a half years of its operation. RESULTS Young people attended ITP for only on average 28.41 days. Over this time they made significant improvements in a range of domains, including weight gain, eating disorder symptomatology, motivation to recover, quality of life and comorbid symptomatology. Young people continued to make improvements post ITP in outpatient treatment provided by the same service and 73.2% had a good or an intermediate outcome at the point of discharge from the service. DISCUSSION This uncontrolled case series indicates that ITP can contribute to positive outcomes for young people who require intensification of treatment. ITP outcomes are discussed in comparison to the published literature concerning day programs for adolescents with a diagnosis of an eating disorder.
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Affiliation(s)
- Mima Simic
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Catherine S Stewart
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ivan Eisler
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Julian Baudinet
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katrina Hunt
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jayne O'Brien
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Beth McDermott
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Northamptonshire Community Eating Disorder Team, Northamptonshire Healthcare NHS Foundation Trust, Northampton, United Kingdom
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Abstract
Higher levels of care (HLC)-including inpatient hospitalization, residential treatment, partial hospitalization, and intensive outpatient treatment-are frequently utilized within routine care for eating disorders. Despite widespread use, there is limited research evaluating the efficacy of HLC, as well as clinical issues related to care in these settings. This review describes the different levels of care for eating disorders and briefly reviews the most up-to-date guidelines and research regarding how to choose a level of care. In addition, as HLC approaches for ED continue to be developed and refined, pragmatic and conceptual challenges have emerged that provide barriers to clinical efficacy and the execution of high-quality treatment research. This review includes a discussion of various issues specific to HLC, as well as a summary of recent literature addressing them.
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Fewell LK, Levinson CA, Stark L. Depression, worry, and psychosocial functioning predict eating disorder treatment outcomes in a residential and partial hospitalization setting. Eat Weight Disord 2017; 22:291-301. [PMID: 28271454 DOI: 10.1007/s40519-016-0357-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022] Open
Abstract
This retrospective study explores depression, worry, psychosocial functioning, and change in body mass index (BMI) as predictors of eating disorder (ED) symptomatology and BMI at discharge and 1-year follow-up from a residential and partial hospitalization ED treatment center. Participants were 423 male and female patients receiving treatment at an ED treatment center. Results indicate significant improvement in ED symptomatology, psychological impairment, and change in BMI (in patients with anorexia nervosa) at treatment discharge and follow-up compared to treatment admission (ps < 0.001). Depression and worry predicted ED symptomatology and psychological impairment at discharge (ps < 0.05). Depression, worry, and psychosocial functioning predicted ED symptomatology and psychological impairment at 1-year follow-up (ps < 0.001). Change in BMI was not a significant predictor of outcome. Depression, worry, and psychosocial functioning each play a role in treatment outcomes and may help clarify who might benefit from treatment. Clinicians in ED treatment centers should consider these as areas of focus for improved outcomes.
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Affiliation(s)
- Laura K Fewell
- McCallum Place Eating Disorder Centers, 231 W. Lockwood Ave, St. Louis, MO, 63119, USA
| | - Cheri A Levinson
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, 63130, USA. .,Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, 40292, USA.
| | - Lynn Stark
- McCallum Place Eating Disorder Centers, 231 W. Lockwood Ave, St. Louis, MO, 63119, USA
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11
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Marzola E, Panepinto C, Delsedime N, Amianto F, Fassino S, Abbate-Daga G. A factor analysis of the meanings of anorexia nervosa: intrapsychic, relational, and avoidant dimensions and their clinical correlates. BMC Psychiatry 2016; 16:190. [PMID: 27267935 PMCID: PMC4897918 DOI: 10.1186/s12888-016-0894-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/31/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a difficult to treat disorder characterized by ambivalence towards recovery and high mortality. Eating symptomatology has a sort of adaptive function for those who suffer from AN but no studies have to date investigated the relationship between the reported meanings of AN and patients' clinical characteristics. Therefore, we aimed to perform a factor analysis of a new measure testing its psychometric properties in order to clarify whether subjective meanings of AN can be related to AN severity, to ascertain if some personality traits correlate with the meanings attributed to AN by patients, and finally to verify to what extent such meanings relate to patients' duration of both illness and treatment. METHODS Eighty-one inpatients affected by AN were recruited for this study and clinical data were recorded. Participants were asked to complete a novel instrument, the Meanings of Anorexia Nervosa Questionnaire (MANQ) focused on the measurement of values that patients attribute to AN and other measures as follows: Eating Disorders Inventory-2, Beck Depression Inventory, Temperament and Character Inventory, and Anorexia Nervosa Stages of Change Questionnaire. RESULTS As measured by the MANQ, body dissatisfaction, problems of adolescence, and distress at school or work mainly triggered the onset of AN. Balance and self-control were mostly reported as meanings of AN while the most frequent negative effects were: being controlled by the illness, obsessive thoughts about body shape, and feeling alone. Differences were found between diagnostic subtypes. When a factorial analysis was performed, three factors emerged: intrapsychic (e.g., balance/safety, self-control, control/power, way to be valued), relational (e.g., communication, way to be recognized), and avoidant (e.g., the avoidance of negative feelings, emotions, and experiences). These factors correlated with patients' personality and motivation to treatments but were unrelated to duration of both illness and treatments. CONCLUSIONS Given the ego-syntonic nature of AN, the understanding of patients' value of their disorder could be relevant in treatment; moreover, the positive value of AN resulted to be unrelated to the duration of both illness and treatments. Future research is warranted to replicate these findings and test their clinical implications.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Corine Panepinto
- 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
| | - Federico Amianto
- 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.
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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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.
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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
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13
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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.
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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
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14
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Abbate-Daga G, Marzola E, De-Bacco C, Buzzichelli S, Brustolin A, Campisi S, Amianto F, Migliaretti G, Fassino S. Day Hospital Treatment for Anorexia Nervosa: A 12-Month Follow-up Study. EUROPEAN EATING DISORDERS REVIEW 2015; 23:390-8. [PMID: 25974364 DOI: 10.1002/erv.2369] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/14/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022]
Abstract
Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence-based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty-six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12-month follow-up evaluation (T18) using Eating Disorders Inventory-2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy-eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long-standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow-up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Carlotta De-Bacco
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Sara Buzzichelli
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Stefania Campisi
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giuseppe Migliaretti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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15
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Experience of an eating disorders out-patient program in an internal medicine hospital. Eat Weight Disord 2013; 18:429-35. [PMID: 24097344 DOI: 10.1007/s40519-013-0073-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The aim of this study was to develop a successful low budget out-patient program, in an internal medicine hospital, for patients presenting eating disorders in an emerging nation. METHODS A total of 144 patients were included in a 6 month intervention centered in medical support, with fortnightly medical consultations, monthly counseling by a nutritionist and by a psychiatrist and three psycho-educational courses. The Three Factor Eating Questionnaire and the Eating Disorders Inventory-2 were performed at the beginning and at the end of the study. RESULTS After 6 months, more than half of the patients who completed the intervention were on remission. Substantial improvement was observed regarding the scores of both instruments after completion of the program. CONCLUSIONS The outcome of this study compares favorably to previous published data of more intensive programs. These results were obtained having little infrastructure, a low budget and limited human resources, making this a suitable eating disorders program for emerging nations.
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Goddard E, Hibbs R, Raenker S, Salerno L, Arcelus J, Boughton N, Connan F, Goss K, Laszlo B, Morgan J, Moore K, Robertson D, S S, Schreiber-Kounine C, Sharma S, Whitehead L, Schmidt U, Treasure J. A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 2013; 13:287. [PMID: 24200194 PMCID: PMC3871017 DOI: 10.1186/1471-244x-13-287] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/15/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. METHOD Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). RESULTS One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. CONCLUSIONS Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.
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Affiliation(s)
- Elizabeth Goddard
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Laura Salerno
- Department of Psychology, University of Palermo, Palermo, Italy
| | - Jon Arcelus
- Eating Disorders Service, Brandon Unit, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Nicky Boughton
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK
| | - Ken Goss
- Eating Disorders Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - Bert Laszlo
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - John Morgan
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | - Kim Moore
- Kinver Centre, Eating Disorders, South Staffordshire and Shropshire NHS Foundation Trust, Staffordshire, UK
| | - David Robertson
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Saeidi S
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | | | - Sonu Sharma
- Eating Disorders Service, The Priory Hospital Cheadle Royal, Manchester, UK
| | - Linette Whitehead
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
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Bégin C, Gagnon-Girouard MP, Aimé A, Ratté C. Trajectories of eating and clinical symptoms over the course of a day hospital program for eating disorders. Eat Disord 2013; 21:249-64. [PMID: 23600555 DOI: 10.1080/10640266.2013.779188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although it is well-established that day hospital programs for eating disorders significantly reduce clinical symptoms, the pre-test/post-test designs that were previously used do not provide information regarding the trajectory of symptoms during treatment. This study observed, on a weekly basis, the evolution of symptoms of 61 women suffering from eating disorders engaged in a day hospital program, and compared the trajectories of specific subgroups of patients. Results show that (a) the first half of the program was crucial for symptom changes; (b) although completers and non-completers presented similar initial improvement, their trajectories rapidly differentiated; and (c) poorer respondents initially reported more symptoms, showed a slower improvement, and never reached the non-clinical zone, whereas better-respondents reached the non-clinical cut-off point more rapidly.
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Affiliation(s)
- Catherine Bégin
- School of Psychology, Laval University, Quebec, Quebec, Canada
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18
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Abbate-Daga G, Marzola E, Gramaglia C, Brustolin A, Campisi S, De-Bacco C, Amianto F, Fassino S. Emotions in eating disorders: changes of anger control after an emotion-focused day hospital treatment. EUROPEAN EATING DISORDERS REVIEW 2012; 20:496-501. [PMID: 22930643 DOI: 10.1002/erv.2199] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Emotional states are key elements of eating disorders (EDs), with anger and aggressiveness playing an important role. This study aimed to investigate anger features in ED patients before and after an intensive day hospital (DH) specifically focused on emotions. METHOD Forty-one ED patients were admitted to our DH, which specifically includes emotion-focused activities. They completed self-reported questionnaires at the beginning and after the intervention: Eating Disorders Inventory-2, State-Trait Anger Expression Inventory (STAXI) and Beck Depression Inventory (BDI). RESULTS Anger Control (Axcon) subscale of STAXI decreased significantly, and both BDI and body mass index - in case of underweight patients - significantly improved after completion of DH. Axcon decrease correlated with BMI improvement. The majority of individuals showing good outcome reported also a significant improvement in Axcon levels. DISCUSSION This study provided preliminary data about the effectiveness - mainly in anger coping - of an emotion-focused DH.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, Section of Psychiatry, University of Turin, Italy.
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19
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Cinematherapy in the day hospital treatment of patients with eating disorders. Case study and clinical considerations. ARTS IN PSYCHOTHERAPY 2011. [DOI: 10.1016/j.aip.2011.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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