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Martini M, Longo P, Di Benedetto C, Delsedime N, Panero M, Abbate-Daga G, Toppino F. Nasogastric Tube Feeding in Anorexia Nervosa: A Propensity Score-Matched Analysis on Clinical Efficacy and Treatment Satisfaction. Nutrients 2024; 16:1664. [PMID: 38892597 PMCID: PMC11174568 DOI: 10.3390/nu16111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
The choice of a refeeding strategy is essential in the inpatient treatment of Anorexia Nervosa (AN). Oral nutrition is usually the first choice, but enteral nutrition through the use of a Nasogastric Tube (NGT) often becomes necessary in hospitalized patients. The literature provides mixed results on the efficacy of this method in weight gain, and there is a scarcity of studies researching its psychological correlates. This study aims to analyze the effectiveness of oral versus enteral refeeding strategies in inpatients with AN, focusing on Body Mass Index (BMI) increase and treatment satisfaction, alongside assessing personality traits. We analyzed data from 241 inpatients, comparing a group of treated vs. non-treated individuals, balancing confounding factors using propensity score matching, and applied regression analysis to matched groups. The findings indicate that enteral therapy significantly enhances BMI without impacting treatment satisfaction, accounting for the therapeutic alliance. Personality traits showed no significant differences between patients undergoing oral or enteral refeeding. The study highlights the clinical efficacy of enteral feeding in weight gain, supporting its use in severe AN cases when oral refeeding is inadequate without adversely affecting patient satisfaction or being influenced by personality traits.
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Affiliation(s)
| | | | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 11, 10126 Turin, Italy; (M.M.); (P.L.); (C.D.B.); (N.D.); (M.P.); (F.T.)
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Neipp MC, Ruiz Á, Manchón J, León-Zarceño E, Quiles MJ, Quiles Y. Quality of Life and Clinical Impairment in Spanish Adolescent Anorexia Nervosa Patients. Eur J Investig Health Psychol Educ 2024; 14:1425-1436. [PMID: 38785592 PMCID: PMC11120447 DOI: 10.3390/ejihpe14050094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Eating disorders have serious physical, mental and social consequences that can affect the quality of life of the sufferer. This study aimed to evaluate the relationship between the severity of ED-related psychopathology and clinical impairment in adolescents with anorexia nervosa (AN) as well as their perception of health-related quality of life. Eighty-six Spanish young women with AN completed a set of questionnaires assessing eating disorder pathology, clinical impairment, and quality of life. The set included the following instruments: the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, Short Form-12 Item Health Survey, and the Eating Disorder-Specific Heath-Related Quality of Life instrument. Descriptive and regression analyses were applied to identify associations between variables. Higher scores on clinical impairment domains were associated with greater impairment of mental and physical health. Moreover, clinical impairment domains and concerns due to ED were related to a lower quality of life. In conclusion, adolescents with AN have a poor quality of life. Moreover, the findings suggest that the clinical features of impairment may serve as severity indicators of quality of life.
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Affiliation(s)
- Marie-Carmen Neipp
- Department of Health Psychology, University of Miguel Hernández, 03202 Elche, Spain
| | - Álvaro Ruiz
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Javier Manchón
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Eva León-Zarceño
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - María José Quiles
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
| | - Yolanda Quiles
- Department of Behavioural Sciences and Health, University of Miguel Hernández, 03202 Elche, Spain; (Á.R.); (J.M.); (E.L.-Z.); (M.J.Q.); (Y.Q.)
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Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord 2024; 12:48. [PMID: 38654374 DOI: 10.1186/s40337-024-01006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. OBJECTIVES This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. METHODS We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. RESULTS Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, "Psychotherapy", mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves "Pharmacological Treatments". Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, "Brain Stimulation Therapies," such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. CONCLUSIONS SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.
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Affiliation(s)
- Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Alessandro Ravaglia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Giovanna Bosco
- Department of Clinical Nutrition, AUSL Bologna, Bologna, Italy
| | - Giorgia Marconi
- U.O. Cure Primarie, AUSL Area Vasta Romagna, Ambito di Rimini, Rimini, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Herpertz-Dahlmann B, Dahmen B, Zielinski-Gussen IM, Seitz J. [New aspects in etiology and treatment of adolescent anorexia nervosa-a postulated bio-psycho-social model and the impact of the COVID-19 pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:400-408. [PMID: 38498187 PMCID: PMC10995062 DOI: 10.1007/s00103-024-03856-y] [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: 12/09/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
Anorexia nervosa is one of the most frequent chronic disorders of adolescence associated with a high mortality. During the COVID-19-pandemic, the number of hospitalized children and adolescents with anorexia nervosa significantly increased. This article outlines new research findings to decode the etiology of this serious disorder, especially a genetic disposition and changes of metabolism. Against the background of increasing rates during the COVID-19 pandemic, the importance of the gene-environment interaction is discussed, and new treatment forms are described. Besides the development of new biological treatment strategies, there is also some important progress in psychotherapeutic interventions. Carers should always be integrated when treating children and adolescents with anorexia nervosa, which is especially emphasized in the new "home treatment" setting. The new concept of anorexia nervosa as a metabo-psychiatric disorder gives us hope for new research ideas and treatment strategies in this often-debilitating disorder of childhood and adolescence.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland.
| | - Brigitte Dahmen
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland
| | - Ingar M Zielinski-Gussen
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland
| | - Jochen Seitz
- Klinik f. Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, LVR-Klinikum Essen, 45147, Essen, Deutschland
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Abry F, Gorwood P, Hanachi M, Di Lodovico L. Longitudinal investigation of patients receiving involuntary treatment for extremely severe anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:179-187. [PMID: 37690079 DOI: 10.1002/erv.3033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/05/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Involuntary treatment may be a life-saving option for extremely severe anorexia nervosa (AN) in the context of life-threatening conditions and refusal of care. The long-term outcomes of patients undergoing involuntary treatment for AN are poorly understood. This study aims to explore quality of life, long-term outcomes and attitudes towards involuntary treatment in patients involuntarily treated for extremely severe AN. METHODS 23 patients involuntarily admitted for extremely severe AN (I-AN), and 25 voluntarily admitted patients (V-AN) were compared for body mass index (BMI), residual symptoms, quality of life, and attitudes towards treatment almost four years after discharge. In I-AN, clinical variables were also compared between admission and follow-up. RESULTS At follow-up, weight restoration was higher in V-AN (p = 0.01), while differences in quality of life, BMI, and mortality rates were not significant between I-AN and V-AN (p > 0.05). In I-AN, BMI increased and weight-controlling strategies decreased at follow-up (p < 0.05). Despite negative experiences of involuntary treatment, the perception of the necessity of treatment increased from admission to follow-up (p < 0.01) and became comparable to V-AN (p > 0.05). DISCUSSION Involuntary treatment for AN does not appear to be a barrier to weight gain and clinical improvement, nor to long-term attitudes towards treatment.
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Affiliation(s)
- Florent Abry
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Mouna Hanachi
- Clinical Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Villejuif, France
- UMR Micalis Institute, INRA, Paris-Saclay University, Jouy-En-Josas, France
| | - Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
- NeuroCentre Magendie, INSERM U1215, Bordeaux, France
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Zhu J, Hay PJ, Yang Y, Le Grange D, Lacey JH, Lujic S, Smith C, Touyz S. Specific psychological therapies versus other therapies or no treatment for severe and enduring anorexia nervosa. Cochrane Database Syst Rev 2023; 8:CD011570. [PMID: 37610143 PMCID: PMC10445422 DOI: 10.1002/14651858.cd011570.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Anorexia nervosa is a psychological condition characterised by self-starvation and fear or wait gain or other body image disturbance. The first line of treatment is specific psychological therapy; however, there is no consensus on best practice for treating people who develop severe and enduring anorexia nervosa (SEAN). Notably, there is no universal definition of SEAN. OBJECTIVES To evaluate the benefits and harms of specific psychological therapies for severe and enduring anorexia nervosa compared with other specific therapies, non-specific therapies, no treatment/waiting list, antidepressant medication, dietary counselling alone, or treatment as usual. SEARCH METHODS We used standard, extensive Cochrane search methods. The last search date was 22 July 2022. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) of people (any age) with anorexia nervosa of at least three years' duration. Eligible experimental interventions were any specific psychological therapy for improved physical and psychological health in anorexia nervosa, conducted in any treatment setting with no restrictions in terms of number of sessions, modality, or duration of therapy. Eligible comparator interventions included any other specific psychological therapy for anorexia nervosa, non-specific psychological therapy for mental health disorders, no treatment or waiting list, antipsychotic treatment (with or without psychological therapy), antidepressant treatment (with or without psychological therapy), dietary counselling, and treatment as usual as defined by the individual trials. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were clinical improvement (weight restoration to within the normal weight range for participant sample) and treatment non-completion. Results were presented using the GRADE appraisal tool. MAIN RESULTS We found two eligible studies, but only one study provided usable data. This was a parallel-group RCT of 63 adults with SEAN who had an illness duration of at least seven years. The trial compared outpatient cognitive behaviour therapy for SEAN (CBT-SEAN) with specialist supportive clinical management for SEAN (SSCM-SE) over eight months. It is unclear if there is any difference between the effect of CBT-SEAN versus SSCM-SE on clinical improvement at 12 months (risk ratio (RR) 1.42, 95% confidence interval (CI) 0.66 to 3.05) or treatment non-completion (RR 1.72, 95% CI 0.45 to 6.59). There were no reported data on adverse effects. The trial was at high risk of performance and detection bias. We rated the GRADE level of evidence as very low-certainty for both primary outcomes, downgrading for imprecision and risk of bias concerns. AUTHORS' CONCLUSIONS This review reports evidence from one trial that evaluated CBT-SEAN versus SSCM-SE. There was very low-certainty evidence of little or no difference in clinical improvement and treatment non-completion between the two therapies. There is a need for larger high-quality trials to determine the benefits of specific psychological therapies for people with SEAN. These should take into account the duration of illness as well as participants' previous experience with evidence-based psychological therapy for anorexia nervosa.
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Affiliation(s)
- James Zhu
- Sydney Local Health District, Sydney, NSW, Australia
| | - Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
- Mental Health Services, WSLHD, Campbelltown, Australia
| | - Yive Yang
- Translational Health Research Institute, Western Sydney University, Campbelltown, Australia
| | | | | | - Sanja Lujic
- Centre for Big Data Research in Health, UNSW, Sydney, Australia
| | - Caroline Smith
- NICM Health Research Institute, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Sydney, Australia
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Rohde J, Obbarius A, Voigt B, Sarrar L, Biesenthal-Matthes S, Kind CS, Rose M, Hofmann T. Differences and similarities in personality functioning across different types of eating disorders. Front Psychiatry 2023; 14:1155725. [PMID: 37324816 PMCID: PMC10267354 DOI: 10.3389/fpsyt.2023.1155725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Objective The classification of anorexia nervosa (AN) into subtypes is relevant due to their different symptomatology. However, subtypes (restricting type: AN-R; purging type: AN-P) differ also in terms of their personality functioning. Knowledge about these differences would allow for better treatment stratification. A pilot study indicated differences in structural abilities that can be assessed by the operationalized psychodynamic diagnosis (OPD) system. The aim of this study was therefore to systematically explore differences in personality functioning and personality between the two AN subtypes and bulimia nervosa (BN) using three personality (functioning) constructs. Methods A total of N = 110 inpatients with AN-R (n = 28), AN-P (n = 40), or BN (n = 42) were recruited in three clinics for psychosomatic medicine. Assignment to the three groups was performed using a comprehensive questionnaire validated for diagnostic purposes (Munich-ED-Quest). Personality functioning was examined using OPD Structure Questionnaire (OPD-SQ), personality by using the Personality Inventory for DSM-5-Brief Form and Big Five Inventory-10. (M)ANOVAs were used to examine differences across eating disorder groups. In addition, correlation and regression analyses were conducted. Results We observed differences on several sub- and main scales of the OPD-SQ. Whereas patients with BN showed the lowest levels, AN-R patients displayed the highest levels of personality functioning. On some sub- and main scales, such as "affect tolerance," the subtypes of AN differed from BN, whereas on the scale "affect differentiation," AN-R, differed from the other two groups. The total eating disorder pathology score of the Munich-ED-Quest best predicted overall personality structure [stand. β = 0.650; t(104) = 6.666; p < 0.001] and self-regulation [stand. β = 0.449; t(104) = 3.628; p < 0.001]. Discussion Our findings confirm most of the results of the pilot study. These findings can facilitate the development of stratified treatment approaches for eating disorders.
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Affiliation(s)
- Jens Rohde
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Barbara Voigt
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea Sarrar
- Department of Psychology, Faculty of Sciences, Medical School Berlin, Berlin, Germany
| | - Silke Biesenthal-Matthes
- Department of Psychosomatic Medicine and Psychotherapy, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Clara-Sophia Kind
- Department of Psychosomatic Medicine and Psychotherapy, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, DRK Kliniken Berlin Wiegmann Klinik, Berlin, Germany
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Accurso EC, Cheng J, Machen VI, Buckelew S, Kreiter A, Adams S, Le Grange D, Golden NH, Garber AK. Hospital-based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa. Int J Eat Disord 2023; 56:1219-1227. [PMID: 36919264 PMCID: PMC10247438 DOI: 10.1002/eat.23931] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard-of-care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments. METHOD Participants (N = 111) in this multisite randomized clinical trial were ages 12-24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post-meals) and daily affective state during the hospitalization. RESULTS About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023). DISCUSSION Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. PUBLIC SIGNIFICANCE The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal-time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.
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Affiliation(s)
- Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Jing Cheng
- Department of Preventive & Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Vanessa I Machen
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Sara Buckelew
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Anna Kreiter
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sally Adams
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, 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
| | - Neville H Golden
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrea K Garber
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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Reay M, Holliday J, Stewart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorders. J Eat Disord 2022; 10:128. [PMID: 36038898 PMCID: PMC9421634 DOI: 10.1186/s40337-022-00648-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery rates for people with eating disorders are low; fewer than half recover and approximately 20% develop a longstanding eating disorder. Patients with longstanding eating disorders are often referred to as "SEED" (severe and enduing eating disorders) although this remains controversial and is not acknowledged in the British treatment guidance. This project aimed to generate recommendations for a longstanding eating disorder care pathway by identifying what proportion of patients have longstanding eating disorders and how to best identify and support them. METHODS Initially, a literature review was completed, followed by interviews with service-users who consider themselves to have longstanding eating disorders, and focus groups with staff members. The results were combined to create a definition of a longstanding eating disorder which was used to establish how many service-users could benefit from the pathway. The qualitative data was used to produce recommendations for a tailored pathway for those with longstanding eating disorders. RESULTS The results highlighted that, although "SEED" is often used, participants preferred to be referred to as "longstanding" or having no label. Qualitative analysis identified four themes in relation to supporting this population group which described how to structure the service and individualise care, as well as patients' relationship to the service, and how to build a life after eating disorder services. CONCLUSIONS Recommendations included promoting a hopeful message, focusing on quality of life and introducing peer support. Crucially, accessing the pathway should not result in being labelled "SEED", nor should it prevent access to recovery focused interventions including weight restoration. The full list of recommendations are included as well as the implications of the project and limitations.
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Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | | | - Joanna Adams
- The Oxford Institute for Clinical Psychology Training and Research, Oxford, UK
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11
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Cribben H, Macdonald P, Treasure J, Cini E, Nicholls D, Batchelor R, Kan C. The experiential perspectives of parents caring for a loved one with a restrictive eating disorder in the UK. BJPsych Open 2021. [PMCID: PMC8517852 DOI: 10.1192/bjo.2021.1019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Parents of a loved one with an eating disorder report high levels of unmet needs. Research is needed to understand whether clinical guidance designed to improve the experience of parents has been effective. Aims To establish parents’ experiential perspectives of eating disorder care in the UK, compared with guidance published by Beat, a UK eating disorders charity, and Academy for Eating Disorders, the leading international eating disorders professional association. Method A total of six focus groups (one online and five face-to-face) were held throughout the UK. A total of 32 parents attended. All participants were parents of a loved one with a diagnosis of anorexia nervosa or atypical anorexia nervosa (mean age 22 years; mean duration of illness 4.4 years). Focus groups were transcribed, and the text was analysed with an inductive approach, to identify emerging themes. Results Four key themes were identified: (a) impact of eating disorder on one's life, (b) current service provisions, (c) navigating the transition process and (d) suggestions for improvement. Conclusions Current experiences of parents in the UK do not align with the guidelines published by Beat and Academy of Eating Disorders. Parents identified a number of changes that healthcare providers could make, including improved information and support for parents, enhanced training of professionals, consistent care across all UK service providers, policy changes and greater involvement of families in their loved one's care. Findings from this project informed the design of a national web-survey on loved ones’ experience of care in eating disorders.
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Affiliation(s)
- Hannah Cribben
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- Correspondence: Hannah Cribben.
| | - Pamela Macdonald
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Erica Cini
- East London Eating Disorder Service for Children and Young People, East London NHS Foundation Trust, UK; and Nutrition Science Group, Division of Medicine, University College London, UK
| | | | - Rachel Batchelor
- Royal Holloway, Department of Psychology, University of London, UK
| | - Carol Kan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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12
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Broomfield C, Rhodes P, Touyz S. Lived experience perspectives on labeling and defining long-standing anorexia nervosa. J Eat Disord 2021; 9:101. [PMID: 34391479 PMCID: PMC8364069 DOI: 10.1186/s40337-021-00457-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Since efforts to stage anorexia nervosa (AN) revealed the existence of various presentations, research into the long-standing subgroup has increased. A change in treatment has been proposed with the intention to use more effective evidence-based methods that target symptoms of the long-standing presentation and improve prognosis. A barrier in achieving this goal in both research and clinical contexts is the lack of a consistent label and definition. This makes the ability to assess, recruit and treat these presentations difficult. Investigations into how this subgroup may be differentiated from other stages of the disorder have included the opinions of practitioners and researchers with little consideration for the perspectives of individuals living with this illness. It was the aim of the current study to investigate lived experience perspectives on the way long-standing AN should be labeled and defined. METHODS Data were collected through a semi-structured interview within a narrative inquiry framework. This approach is beneficial when examining processes that occur over time, such as investigations into a long-term illness. A total of 11 women with a presentation of long-standing AN participated in an interview. Data were divided into two categories for analysis based on the association to labeling or defining the features of the long-standing AN illness. RESULTS Two labels emerged during the analysis with participants describing a preference for the use of 'severe and enduring' over 'chronic' when referring to their presentation of AN. When defining the illness, the most preferred criterion was illness duration with mixed perspectives for the use of previously failed treatment attempts. Participants described a consistent dislike for the use of low body weight as a feature in the defining of the illness. CONCLUSIONS The current study describes how individuals with a lived experience prefer to have the long-standing AN presentation labeled and defined. It is the hope of the authors that these insights will be adopted into any guidelines developed to ensure individuals most affected by this disorder have a voice and continue to be given the opportunity to contribute to topics related to their illness. Anorexia nervosa (AN) is a complex illness that has been divided into stages based on the severity of symptoms. Little is known about the AN stage that persists over lengthy periods of time with research pursuits underway to determine characteristics that allow this disorder to persevere. A barrier in researching and treating these individuals is the lack of a consistent label to refer to these presentations and criteria that will allow us to identify this stage of AN. The aim of the current study was to determine how individuals with a lived experience of long-standing AN prefer to have their illness labeled and defined. A total of 11 women who had experienced this stage of AN were interviewed with the majority of participants reporting to prefer the label 'severe and enduring' over the term 'chronic'. Additionally, most of the participants had a preference for defining their illness based on the duration of time the illness had persisted with mixed opinions for using the number of previously unsuccessful treatment attempts as criterion. The authors are hopeful that any guidelines established for labeling and defining long-standing AN will incorporate the perspectives of individuals with a lived experience of the illness.
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Affiliation(s)
- Catherine Broomfield
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Paul Rhodes
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
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13
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Broomfield C, Stedal K, Touyz S. The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review. Front Psychol 2021; 12:708536. [PMID: 34408714 PMCID: PMC8365190 DOI: 10.3389/fpsyg.2021.708536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Characteristics of Severe and Enduring Anorexia Nervosa (SE-AN) are being investigated to differentiate the patients experiencing SE-AN from those at earlier stages of the AN disease. The current systematic review was the first step in exploring neuropsychological functioning as a potentially identifying characteristic for long-term presentations. With a subgroup of AN patients reflecting a unique neuropsychological profile that is proportionate to the quantity of patients that go on to develop SE-AN, it was the aim of this review to assess neuropsychological functioning in the later stage of the disease. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science, and Scopus) for neuropsychological research on AN participants with a seven or more year illness duration. Datasets that met inclusion criteria were screened for SE-AN participants (N = 166) and neuropsychological data extracted together with potentially confounding variables and information required to conduct a quality assessment. In research investigating decision-making, participants with a SE-AN presentation demonstrated significantly lower functioning compared to healthy controls. There was conflicting evidence for differences in intellectual functioning and set-shifting abilities with no variability indicated in central coherence, memory, attention, reasoning, or processing speed. If findings from this preliminary analysis are confirmed through empirical research, implications include earlier identification of SE-AN patients and more effective treatment development.
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Affiliation(s)
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål, Norway
| | - Stephen Touyz
- Inside Out Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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14
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Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria. J Clin Med 2021; 10:jcm10143190. [PMID: 34300355 PMCID: PMC8307185 DOI: 10.3390/jcm10143190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 12/12/2022] Open
Abstract
This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.
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15
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Todisco P, Meneguzzo P, Garolla A, Antoniades A, Vogazianos P, Tozzi F. Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study. Eat Weight Disord 2021; 26:869-877. [PMID: 32430886 DOI: 10.1007/s40519-020-00916-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/02/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs). METHODS 320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient. RESULTS Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037). DISCUSSION Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings. LEVEL OF EVIDENCE III, cohort or case-control analytic studies.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | - Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy. .,Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University Cyprus, Engomi, Cyprus
| | - Federica Tozzi
- Research and Development, Stremble Ventures, Limassol, Cyprus
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16
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Fernández-Aranda F, Treasure J, Paslakis G, Agüera Z, Giménez M, Granero R, Sánchez I, Serrano-Troncoso E, Gorwood P, Herpertz-Dahlmann B, Bonin EM, Monteleone P, Jiménez-Murcia S. The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept. EUROPEAN EATING DISORDERS REVIEW 2021; 29:499-513. [PMID: 33599348 DOI: 10.1002/erv.2822] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE There are no generally accepted definitions or markers of treatment nonresponse in eating disorders (EDs). The aim of this paper was to examine how the duration of illness and other potential prognostic markers impacted on nonresponse and drop-out from treatment across different EDs subtypes. METHODS A total sample of 1199 consecutively treated patients with EDs, according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria, participated in this study. Kaplan-Meier curves were calculated for each ED diagnosis in which the probability of recovery was plotted against the duration of illness. RESULTS Full remission was more likely for people with binge eating disorder (BED; 47.4%) and anorexia nervosa (AN; 43.9%) compared to bulimia nervosa (BN; 25.2%) and other specified feeding and EDs (OSFED; 23.2%). The cut-off points for the duration of the illness related with high likelihoods of poor response was 6-8 years among OSFED, 12-14 years among AN and BN and 20-21 years among BED. Other variables predicting nonresponse included dysfunctional personality traits. CONCLUSIONS Nonresponse to treatment is associated with duration of illness which is in turn associated with poor response to previous treatment. However, there was no evidence for staging the illness using specific duration of illness criteria. Nevertheless, the shorter temporal trajectory for OSFED suggests that early interventions may be of importance for this group.
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Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georgios Paslakis
- Medical Faculty, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Ruhr-University of Bochum, Luebbecke, Germany
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Mónica Giménez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Philip Gorwood
- CMME, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM, U1266, Paris, France
| | - Beate Herpertz-Dahlmann
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen, Aachen, Germany
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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17
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Speciani M, Barak Y, Damanhuri H, De Ronchi D, Panariello F, Atti AR. A Perspective on Chronic and Long-Lasting Anorexia Nervosa. Front Psychiatry 2021; 12:756669. [PMID: 34777061 PMCID: PMC8585925 DOI: 10.3389/fpsyt.2021.756669] [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: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Anorexia Nervosa (AN) is a severe eating disorder which typically develops in younger females. Many studies focus on this specific population, a majority of which will eventually partially or fully recover. A minority will become chronic despite extensive treatment. These patients are treatment-resistant and may not necessarily benefit from usual treatment. In this article we will reflect on possible mechanisms which may explain the maintenance of disease, and especially on the possible role of affective and anxiety disturbances. We will use, due to the lack of large-scale studies, data from risk and prognostic factors, treatment options and neurobiological correlates in chronic AN patients. Lastly, we will propose how these elements may advise further research and treatments.
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Affiliation(s)
- Maurizio Speciani
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Hanafi Damanhuri
- Department of Biochemistry, Faculty of Medicine, UKM Medical Centre, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Fabio Panariello
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
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18
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Glasofer DR, Muratore AF, Attia E, Wu P, Wang Y, Minkoff H, Rufin T, Walsh BT, Steinglass JE. Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa. J Eat Disord 2020; 8:69. [PMID: 33292619 PMCID: PMC7709230 DOI: 10.1186/s40337-020-00348-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. METHODS Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual's likelihood of maintaining inpatient treatment gains. RESULTS One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. CONCLUSIONS Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.
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Affiliation(s)
- Deborah R Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA.
| | - Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
- Center for Eating Disorders, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA
| | - Peng Wu
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Hillary Minkoff
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Teresa Rufin
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
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19
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Radunz M, Keegan E, Osenk I, Wade TD. Relationship between eating disorder duration and treatment outcome: Systematic review and meta-analysis. Int J Eat Disord 2020; 53:1761-1773. [PMID: 32856329 DOI: 10.1002/eat.23373] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders. METHOD Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted. RESULTS First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: -.03:.13), with high heterogeneity. Second, we conducted three sub-group analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/-.06, respectively. High levels of heterogeneity were present. DISCUSSION Duration did not influence treatment outcome across any of our meta-analyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology.
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Affiliation(s)
- Marcela Radunz
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ivana Osenk
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, South Australia, Australia
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20
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Wonderlich SA, Bulik CM, Schmidt U, Steiger H, Hoek HW. Severe and enduring anorexia nervosa: Update and observations about the current clinical reality. Int J Eat Disord 2020; 53:1303-1312. [PMID: 32359125 DOI: 10.1002/eat.23283] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE-AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE-AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE-AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE-AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE-AN and their families.
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Affiliation(s)
- Stephen A Wonderlich
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Howard Steiger
- Eating Disorder Continuum, Douglas Mental Health University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada
| | - Hans W Hoek
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA.,Parnassia Psychiatric Institute, The Hague, The Netherlands
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21
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Kaufmann LK, Hänggi J, Jäncke L, Baur V, Piccirelli M, Kollias S, Schnyder U, Martin-Soelch C, Milos G. Age influences structural brain restoration during weight gain therapy in anorexia nervosa. Transl Psychiatry 2020; 10:126. [PMID: 32366823 PMCID: PMC7198513 DOI: 10.1038/s41398-020-0809-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/22/2023] Open
Abstract
Neuroimaging studies on anorexia nervosa (AN) have consistently reported globally reduced gray matter in patients with acute AN. While first studies on adolescent AN patients provide evidence for the reversibility of these impairments after weight gain, longitudinal studies with detailed regional analysis for adult AN patients are lacking and factors associated with brain restitution are poorly understood. We investigated structural changes in anorexia nervosa using T1-weighted magnetic resonance images with surface-based morphometry. The sample consisted of 26 adult women with severe AN and 30 healthy controls. The longitudinal design comprised three time points, capturing the course of weight-restoration therapy in AN patients at distinct stages of weight gain (BMI ≤ 15.5 kg/m2; 15.5 < BMI < 17.5 kg/m2; BMI ≥ 17.5 kg/m2). Compared to controls, AN patients showed globally decreased cortical thickness and subcortical volumes at baseline. Linear mixed effect models revealed the reversibility of these alterations, with brain restoration being most pronounced during the first half of treatment. The restoration of cortical thickness of AN patients negatively correlated with age, but not duration of illness. After weight restoration, residual group differences of cortical thickness remained in the superior frontal cortex. These findings indicate that structural brain alterations of adult patients with severe AN recuperate independently of the duration of illness during weight-restoration therapy. The temporal pattern of brain restoration suggests a decrease in restoration rate over the course of treatment, with patients' age as a strong predictor of brain restitution, possibly reflecting decreases of brain plasticity as patients grow older.
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Affiliation(s)
- Lisa-Katrin Kaufmann
- Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland. .,Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Jürgen Hänggi
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- grid.7400.30000 0004 1937 0650Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650University Research Priority Program (URPP) “Dynamic of Healthy Aging”, University of Zurich, Zurich, Switzerland
| | - Volker Baur
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Piccirelli
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Spyros Kollias
- grid.412004.30000 0004 0478 9977Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- grid.8534.a0000 0004 0478 1713Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Gabriella Milos
- grid.7400.30000 0004 1937 0650Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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22
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Zhu J, Yang Y, Touyz S, Park R, Hay P. Psychological Treatments for People With Severe and Enduring Anorexia Nervosa: A Mini Review. Front Psychiatry 2020; 11:206. [PMID: 32265758 PMCID: PMC7106475 DOI: 10.3389/fpsyt.2020.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
This Mini-Review presents recent research into evidence for psychological treatments for people with severe and enduring anorexia nervosa (SEAN). Two psychological therapies, specialist supportive clinical management (SSCM), and cognitive behavior therapy for anorexia nervosa (CBT-AN) have limited (one randomized controlled study) evidence of efficacy. Both have had adaptations for SEAN, notably with revision of the primary treatment goal of improved quality of life and full weight recovery a secondary goal. A major issue with existing studies is poor definition of SEAN, and the large deficit in research that has used an agreed definition of SEAN. In particular, it may be problematic to extrapolate from studies of people with either severe and/or enduring but not intractable or "resistant" illness. People with longstanding AN who have not received evidence based care should be offered this with an expectation of recovery. Similarly, people with SEAN may be offered care with judicious mitigation of expectations. In the future, trials should include people with SEAN clearly defined. Trials with a subsample of participants likely to have SEAN, if identified at randomisation, are an opportunity for secondary analyses of such participants. This would widen the evidence base for psychological treatments providing hope for people with this devastating illness. Finally, there is an urgent need not only to strengthen our existing knowledge with studies of sufficient power, but also, fundamentally, to derive novel conceptualizations of what "treatment" involves.
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Affiliation(s)
- James Zhu
- South West and North Coast Psychiatry Training Network, Sydney Local Health District, Sydney, NSW, Australia
| | - Yive Yang
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Park
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Phillipa Hay
- Western Sydney University, Translational Health Research Institute, Sydney, NSW, Australia
- South Western Sydney Local Health District, Camden and Campbelltown Hospitals, Sydney, NSW, Australia
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23
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Takakura S, Aso CS, Toda K, Hata T, Yamashita M, Sudo N. Physical and psychological aspects of anorexia nervosa based on duration of illness: a cross-sectional study. Biopsychosoc Med 2019; 13:32. [PMID: 31889996 PMCID: PMC6929428 DOI: 10.1186/s13030-019-0173-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background We evaluated physical and psychological features of patients with anorexia nervosa (AN) who differed by duration of illness. Methods Data were obtained from 204 female patients with AN, divided into two groups based on illness duration: short-term illness duration (less than 5 years; n = 118); and long-term duration (5 years or more; n = 86). Physical parameters were measured using blood serum testing and psychological aspects were assessed using various instruments. Results A significantly higher proportion of restricting type AN was observed in the short-term group while the proportion of binge eating/purging type AN was higher in the long-term group. There was no difference in body mass index (BMI) between the groups. Serum total protein, albumin, potassium, chloride, and calcium in the long-term group were significantly lower than in the short-term group. Overall scores on the Eating Disorder Inventory as well as most of the subscales, except maturity fears, were higher in the long-term group than in the short-term group. The care subscale of the Parental Bonding Instrument (PBI) was lower in the long-term group than in the short-term group, while the overprotection subscale of the PBI was higher in the long-term group than in the short-term group. Results of a multiple regression analysis indicated that the overprotection subscale of the PBI was the only significant predictor of duration of illness. Conclusions Duration of illness may be associated with physical and psychological features of AN; thus, adapting therapeutic approaches to illness duration might be necessary.
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Affiliation(s)
- Shu Takakura
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Chie Suzuyama Aso
- 2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kenta Toda
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomokazu Hata
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Makoto Yamashita
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Nobuyuki Sudo
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan.,2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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24
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Hayes NA, Welty LJ, Slesinger N, Washburn JJ. Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders. Eat Disord 2019; 27:305-320. [PMID: 30204570 DOI: 10.1080/10640266.2018.1512302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.
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Affiliation(s)
- Nicole A Hayes
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Leah J Welty
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,b Department of Preventative Medicine, Division of Biostatistics , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Noel Slesinger
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Jason J Washburn
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,c Center for Evidence-Based Practice , AMITA Health Behavioral Medicine, Hoffman Estates , IL , USA
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25
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Gregertsen EC, Mandy W, Kanakam N, Armstrong S, Serpell L. Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis. Psychiatry Res 2019; 271:484-501. [PMID: 30551081 DOI: 10.1016/j.psychres.2018.11.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.
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Affiliation(s)
- Eva C Gregertsen
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - William Mandy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | | | | | - Lucy Serpell
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, London, UK
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26
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Boyd HK, Bodell LP, Jennings KM, Graham AK, Crosby RD, Wildes JE. Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa. Int J Eat Disord 2018; 51:870-878. [PMID: 29734468 PMCID: PMC6222021 DOI: 10.1002/eat.22879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment. METHOD Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters2 )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100. RESULTS At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time. DISCUSSION Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.
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Affiliation(s)
- Hope K. Boyd
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Lindsay P. Bodell
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Karen M. Jennings
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Andrea K. Graham
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | - Ross D. Crosby
- Neuropsychiatric Research Institute,University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science
| | - Jennifer E. Wildes
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience
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27
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Södersten P, Bergh C, Leon M, Brodin U, Zandian M. Cognitive behavior therapy for eating disorders versus normalization of eating behavior. Physiol Behav 2017; 174:178-190. [PMID: 28322911 DOI: 10.1016/j.physbeh.2017.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/18/2017] [Accepted: 03/08/2017] [Indexed: 12/22/2022]
Abstract
We examine the science and evidence supporting cognitive behavior therapy (CBT) for the treatment of bulimia nervosa and other eating disorders. Recent trials focusing on the abnormal cognitive and emotional aspects of bulimia have reported a remission rate of about 45%, and a relapse rate of about 30% within one year. However, an early CBT trial that emphasized the normalization of eating behavior had a better outcome than treatment that focused on cognitive intervention. In support of this finding, another treatment, that restores a normal eating behavior using mealtime feedback, has an estimated remission rate of about 75% and a relapse rate of about 10% over five years. Moreover, when eating behavior was normalized, cognitive and emotional abnormalities were resolved at remission without cognitive therapy. The critical aspect of the CBT treatment of bulimia nervosa therefore may actually have been the normalization of eating behavior.
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Affiliation(s)
- P Södersten
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden.
| | - C Bergh
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - M Leon
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - U Brodin
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - M Zandian
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
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28
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Sibeoni J, Orri M, Valentin M, Podlipski MA, Colin S, Pradere J, Revah-Levy A. Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals. PLoS One 2017; 12:e0169493. [PMID: 28056106 PMCID: PMC5215824 DOI: 10.1371/journal.pone.0169493] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment. METHODS We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program. RESULTS We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool-a relationship, specifically the core concept of the therapeutic relationship. CONCLUSION Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital Centre, Argenteuil, France
- ECSTRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France
| | - Massimiliano Orri
- ECSTRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France
| | - Marie Valentin
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Marc-Antoine Podlipski
- Centre Hospitalier du Rouvray, Fédération Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Rouen - CH du Rouvray, Rouen, France
| | - Stephanie Colin
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Jerome Pradere
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital Centre, Argenteuil, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l’Adolescent, Argenteuil Hospital Centre, Argenteuil, France
- ECSTRA Team, UMR-1153, Inserm, Paris Diderot University, Sorbonne Paris Cite, Paris, France
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29
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Wild B, Friederich HC, Zipfel S, Resmark G, Giel K, Teufel M, Schellberg D, Löwe B, de Zwaan M, Zeeck A, Herpertz S, Burgmer M, von Wietersheim J, Tagay S, Dinkel A, Herzog W. Predictors of outcomes in outpatients with anorexia nervosa - Results from the ANTOP study. Psychiatry Res 2016; 244:45-50. [PMID: 27467700 DOI: 10.1016/j.psychres.2016.07.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
This study aimed to determine predictors of BMI and recovery for outpatients with anorexia nervosa (AN). Patients were participants of the ANTOP (Anorexia Nervosa Treatment of Out-Patients) trial and randomized to focal psychodynamic therapy (FPT), enhanced cognitive behavior therapy (CBT-E), or optimized treatment as usual (TAU-O). N=169 patients participated in the one-year follow-up (T4). Outcomes were the BMI and global outcome (recovery/partial syndrome/full syndrome) at T4. We examined the following baseline variables as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, quality of life, self-esteem, and psychological characteristics relevant to AN. Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome. The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients. Negative predictors for BMI and recovery were a duration of illness >6 years and a lifetime depression diagnosis at baseline. Additionally, higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4. A higher baseline BMI and shorter illness duration led to a better outcome. Further research is necessary to investigate whether or not AN patients with lifetime depression, higher bodily pain, and lower self-esteem may benefit from specific treatment approaches.
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Affiliation(s)
- Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany.
| | | | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Medical School Hanover, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, University of Münster, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Germany
| | - Sefik Tagay
- Department of Psychosomatic Medicine and Psychotherapy, University of Essen, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
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30
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Cooper Z, Allen E, Bailey-Straebler S, Basden S, Murphy R, O'Connor ME, Fairburn CG. Predictors and moderators of response to enhanced cognitive behaviour therapy and interpersonal psychotherapy for the treatment of eating disorders. Behav Res Ther 2016; 84:9-13. [PMID: 27423373 PMCID: PMC4988513 DOI: 10.1016/j.brat.2016.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/18/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Abstract
Consistent predictors, and more especially moderators, of response to psychological treatments for eating disorders have not been identified. The present exploratory study examined predictors and moderators of outcome in adult patients who took part in a randomised clinical trial comparing two leading treatments for these disorders, enhanced cognitive behavioural therapy (CBT-E) and interpersonal psychotherapy (IPT). Four potentially important findings emerged. Firstly, patients with a longer duration of disorder were less likely to benefit from either treatment. Second, across the two treatments the presence, at baseline, of higher levels of over-evaluation of the importance of shape predicted a less good treatment outcome. Third DSM-IV diagnosis did not predict treatment outcome. Fourth, with the exception of patients with baseline low self-esteem who achieved a better outcome with CBT-E, it was generally not possible to identify a subgroup of patients who would differentially benefit from one or other treatment.
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Affiliation(s)
- Zafra Cooper
- Oxford University, Department of Psychiatry, UK.
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, UK
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31
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Peterson CB, Becker CB, Treasure J, Shafran R, Bryant-Waugh R. The three-legged stool of evidence-based practice in eating disorder treatment: research, clinical, and patient perspectives. BMC Med 2016; 14:69. [PMID: 27081002 PMCID: PMC4832531 DOI: 10.1186/s12916-016-0615-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/08/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Evidence-based practice in eating disorders incorporates three essential components: research evidence, clinical expertise, and patient values, preferences, and characteristics. Conceptualized as a 'three-legged stool' by Sackett et al. in 1996 (BMJ), all of these components of evidence-based practice are considered essential for providing optimal care in the treatment of eating disorders. However, the extent to which these individual aspects of evidence-based practice are valued among clinicians and researchers is variable, with each of these stool 'legs' being neglected at times. As a result, empirical support and patient preferences for treatment are not consistently considered in the selection and implementation of eating disorder treatment. In addition, clinicians may not have access to training to provide treatments supported by research and preferred by patients. Despite these challenges, integrating these three components of evidence-based practice is critical for the effective treatment of eating disorders. DISCUSSION Current research supports the use of several types of psychotherapies, including cognitive-behavioral, interpersonal, and family-based therapies, as well as certain types of medications for the treatment of eating disorders. However, limitations in current research, including sample heterogeneity, inconsistent efficacy, a paucity of data, the need for tailored approaches, and the use of staging models highlight the need for clinical expertise. Although preliminary data also support the importance of patient preferences, values, and perspectives for optimizing treatment, enhancing treatment outcome, and minimizing attrition among patients with eating disorders, the extent to which patient preference is consistently predictive of outcome is less clear and requires further investigation. All three components of evidence-based practice are integral for the optimal treatment of eating disorders. Integrating clinical expertise and patient perspective may also facilitate the dissemination of empirically-supported and emerging treatments as well as prevention programs. Further research is imperative to identify ways in which this three-legged approach to eating disorder treatment could be most effectively implemented.
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Affiliation(s)
- Carol B. Peterson
- />Department of Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN 55454 USA
- />The Emily Program, St. Paul, MN USA
| | | | - Janet Treasure
- />Department of Psychological Medicine, IOPPN, King’s College, London, UK
| | - Roz Shafran
- />Institute of Child Health, University College, London, UK
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Gaudiani JL, Brinton JT, Sabel AL, Rylander M, Catanach B, Mehler PS. Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group. Int J Eat Disord 2016; 49:378-85. [PMID: 26332494 DOI: 10.1002/eat.22437] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Relatively little has been written about the outcomes of medical stabilization, analyzed specifically across the age spectrum, in adults with severe anorexia nervosa (AN). METHOD We retrospectively evaluated clinical parameters relevant to acuity of illness and outcomes of early refeeding in 142 adults with severe AN, admitted for definitive inpatient medical stabilization from October 1, 2008 to December 31, 2012. Patients were categorized into three age groups: 17 to 29, 30 to 40, and 41+ years. RESULTS The study included 142 patients with median age of 28 years old (range 17-65 years). Fifty-four percent (n = 78) were under 30 years old, 23% (n = 32) between 30 and 40 years old, and 23% (n = 32) were over 40 years old. Average admission BMI did not differ among age groups, ranging from 12.7 to 13.2 kg/m(2). Of the admission parameters, only low serum albumin levels (more prevalent in older patients), high international normalized ratio (INR) levels (more prevalent in younger patients), and neutropenia (more prevalent in the <30 age group) varied with age. During hospitalization, rates of bradycardia, hypoglycemia, liver dysfunction, very low %IBW, refeeding hypophosphatemia, refeeding edema, length of stay, and discharge BMI did not differ with age. Age group was associated with rate of weekly weight gain only in patients with AN-binge purge subtype. DISCUSSION Results demonstrate medical abnormalities and response to medical stabilization in severely ill AN patients during hospitalization were mostly similar across the age span. This information should allay fears that the effect of age will make medical stabilization more difficult.
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Affiliation(s)
- Jennifer L Gaudiani
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - John T Brinton
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Allison L Sabel
- Department of Patient Safety and Quality, Denver Health, Denver, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado
| | - Melanie Rylander
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Department of Psychiatry, University of Colorado, Denver, Colorado
| | | | - Philip S Mehler
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
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Treasure J. Applying evidence-based management to anorexia nervosa. Postgrad Med J 2016; 92:525-31. [PMID: 26944338 DOI: 10.1136/postgradmedj-2015-133282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/11/2016] [Indexed: 12/28/2022]
Abstract
AIM This paper considers how the three principles of evidence based practice (clinical expertise, scientific evidence, and patient preference) can be applied to the complexity of treatment for anorexia nervosa AN. METHOD A narrative review of the evidence of these three domains is presented. Clinical cases are used to illustrate how the formulation and management can be put into practice at different stages of illness. RESULTS The management of anorexia nervosa is complex. First, individuals with the illness do not regard the manifestations of the illness as a source of concern rather they are embraced and integrated into their identity. This contrasts to the reaction of other people who are terrified by the overt signs of ill health. Thus engagement into treatment is problematic. Second, the core symptom restricted eating, produces malnutrition which impacts on brain, body, and the social network. Thus a mixture of psychological and physical problems gradually accumulates over the course of the illness. This means that the treatment targets increase over time. CONCLUSION Thus treatment has to work with motivation and readiness to change and tackle the various domains of ill health.
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Robinson PH, Kukucska R, Guidetti G, Leavey G. Severe and enduring anorexia nervosa (SEED-AN): a qualitative study of patients with 20+ years of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 23:318-26. [PMID: 26059633 DOI: 10.1002/erv.2367] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 03/05/2015] [Indexed: 11/10/2022]
Abstract
Little is known about how patients with long-term eating disorders manage their clinical problems. We carried out a preliminary qualitative study (using Thematic Analysis) of patients with severe and enduring anorexia nervosa (SEED-AN) in which we undertook recorded interviews in eight participants whose conditions had lasted 20-40 years. We found 15 principle features in physical, psychological, social, family, occupational and treatment realms. Psychological and social realms were most affected. Severe physical problems were reported. They described feelings of unworthiness, frugality regarding money and obsessive time-keeping. Persisting with negligible social networks, participants described depression and hopelessness, while somehow achieving a sense of pride at their endurance and survival in spite of the eating disorder. They emphasized the importance of professional help in managing their care. The severe and enduring description, often reserved for people with psychotic illness, is appropriately applied to SEED-AN, which has major impacts in all realms.
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Affiliation(s)
- Paul H Robinson
- Barnet Enfield and Haringey Mental Health Trust, UK.,University College London, UK
| | | | | | - Gerard Leavey
- University College London, UK.,Ulster University, UK
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Bertens D, Fasotti L, Boelen DH, Kessels RP. Moderators, Mediators, and Nonspecific Predictors of Treatment Outcome in an Intervention for Everyday Task Improvement in Persons With Executive Deficits After Brain Injury. Arch Phys Med Rehabil 2016; 97:97-103. [DOI: 10.1016/j.apmr.2015.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
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Abstract
PURPOSE OF REVIEW Severe and enduring eating disorder is a new concept to the field that has potential to aid assessment and inform treatment. The aim of this review is to report recent developments in the conceptualization and treatment of people with severe and enduring eating disorder. RECENT FINDINGS A systematic search identified 28 included papers. These addressed conceptualization of recovery and staging models (4 studies), clinical care, presentations and treatment experiences (7 studies), four new randomized controlled trials of treatment (9 studies), two open trials of novel approaches (2 studies) and problems of treatment resistance and involuntary care (6 studies). SUMMARY The staging model appears to have validity and clinical utility in anorexia nervosa, but this is less clear in other eating disorders. Most literature on treatment, including new randomised controlled trials, is on underweight individuals, and there is a small literature on emerging psychological therapies that may improve outcomes. There is an expectation that with better treatment engagement, there may also be a reduced need for involuntary interventions.
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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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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Abstract
The aim of this article is to describe the rationale and practice of the New Maudsley collaborative care intervention for families of people with eating disorders. The intervention teaches carers the underpinning theory with practical examples on how to optimize their care giving, communication, and coping skills. This includes moderating high expressed emotion and reducing the tendency to accommodate and/or enable illness behaviors. Transcripts are used to give examples of this approach in action. The emerging evidence base indicates that this approach improves both carer and patient well-being and also is associated with a more efficient use of resources.
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Affiliation(s)
- Janet Treasure
- a Department of Psychological Medicine , Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK
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