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Elwyn R, Adams M, Sharpe SL, Silverstein S, LaMarre A, Downs J, Burnette CB. Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality. J Eat Disord 2024; 12:70. [PMID: 38831456 PMCID: PMC11145809 DOI: 10.1186/s40337-024-01016-w] [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: 01/25/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and psychiatry, Thompson Institute, Birtinya, QLD, Australia
- University of the Sunshine Coast, Birtinya, QLD, Australia
| | | | - Sam L Sharpe
- Fighting Eating Disorders in Underrepresented Populations (FEDUP, Collective), West Palm Beach, FL, USA
| | | | | | | | - C Blair Burnette
- Department of Psychology, Michigan State University, Lansing, MI, USA.
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Ellis A, Gillespie K, McCosker L, Hudson C, Diamond G, Machingura T, Branjerdporn G, Woerwag-Mehta S. Meal support intervention for eating disorders: a mixed-methods systematic review. J Eat Disord 2024; 12:47. [PMID: 38644490 PMCID: PMC11034063 DOI: 10.1186/s40337-024-01002-2] [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: 02/08/2023] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
OBJECTIVE Mealtimes are a period of heightened distress for individuals with eating disorders. Patients frequently display maladaptive coping strategies, such as hiding food and using distraction techniques to avoid eating. The aim of this systematic review is to evaluate the evidence for meal support interventions as a first-line intervention for eating disorders. METHOD Six databases were systematically searched in January 2024. Papers including patients with an eating disorder, and meal support or meal supervision, were examined. Quality appraisal was conducted. RESULTS Ten studies met inclusion criteria. Meal support was conducted individually and in group settings. Two studies examined the practical or interpersonal processes of meal support. Carers and trained clinicians implemented meal support. Individuals across the lifespan were examined. Settings included inpatient units, community clinics, and the home. Studies were heterogeneously evaluated with retrospective chart audits, pre- and post- cohort studies, semi-structured interviews, video analysis, and surveys. DISCUSSION Meal support intervention is potentially suitable and beneficial for patients of various age groups and eating disorder diagnoses. Due to the lack of consistent approaches, it is apparent there is no standardised framework and manualised approach. This highlights the need for the development of a co-designed approach, adequate training, and rigorous evaluation.
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Affiliation(s)
- Aleshia Ellis
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Kerri Gillespie
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Laura McCosker
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Carly Hudson
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia
| | - Gideon Diamond
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | | | - Grace Branjerdporn
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
| | - Sabine Woerwag-Mehta
- Gold Coast Hospital and Health Services, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
- Bond University, 14 University Drive, Robina, QLD, 4226, Australia.
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Guala MM, Bikic A, Bul K, Clinton D, Mejdal A, Nielsen HN, Stenager E, Søgaard Nielsen A. "Maze Out": a study protocol for a randomised controlled trial using a mix methods approach exploring the potential and examining the effectiveness of a serious game in the treatment of eating disorders. J Eat Disord 2024; 12:35. [PMID: 38429839 PMCID: PMC10908122 DOI: 10.1186/s40337-024-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Eating Disorders (ED) are severe and costly mental health disorders. The effects of existing treatment approaches are limited and there is a need to develop novel interventions, including digital strategies that can increase engagement and effectiveness. Maze Out is a new serious game coproduced by patients and ED therapists, which allows patients to "play" with the reality of an ED and reflect on associated challenges. OBJECTIVES The present study has two main objectives: (1) to evaluate the effectiveness of adding Maze Out to treatment as usual (TAU) in a randomised controlled trial (RCT); and (2) to examine in depth the potential of Maze Out by examining how it is perceived and used in the context of an RCT. METHODS Participants will be recruited from mental health care services, endocrinology departments or Community Centres offering treatment for ED. Patients suffering from ED (N = 94) will be randomised to either TAU or TAU plus Maze Out. Primary outcome will be measured in terms of changes in self-efficacy, measured by a 5-item self-efficacy questionnaire (5-item SE_ED). Secondary outcome measures will include feelings of ineffectiveness and self-image, as measured by Eating Disorder Inventory, version 3 (EDI-3), Brief INSPIRE-O and Structural Analysis of Social Behaviour Intrex Questionnaire (SAS-B). Data will be collected at baseline (enrolment in the study), and subsequently 8 and 15 weeks after inclusion. Experiences of playing Maze Out will be examined in a sub-sample of participants, utilising both quantitative user analytics and qualitative interview data of patients, interview data of significant others, and healthcare professionals to explore the possible impact of Maze Out on disorder insight, communication patterns between patients and therapists and understanding of their disorder. DISCUSSION To our knowledge Maze Out is the first serious game coproduced by patients and therapists. It is a novel and theoretically grounded intervention that may significantly contribute to the healing process of ED. If found effective, the potential for wide-spread impact and scalability is considerable. Trial registration ClinicalTrials.gov NCT05621018.
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Affiliation(s)
- Maria Mercedes Guala
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark.
| | - Aida Bikic
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Kim Bul
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics (MEB), Centre for Eating Disorders Innovation (CEDI), Karolinska Institute, Stockholm, Sweden
| | - Anna Mejdal
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Helene Nygaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
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Hemmingsen SD, Lichtenstein MB, Sjögren M, Gudex C, Larsen PV, Støving RK. Cognitive performance in hospitalized patients with severe or extreme anorexia nervosa. Eat Weight Disord 2023; 28:86. [PMID: 37864583 PMCID: PMC10590307 DOI: 10.1007/s40519-023-01585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/29/2023] [Indexed: 10/23/2023] Open
Abstract
PURPOSE Severe malnourishment may reduce cognitive performance in anorexia nervosa (AN). We studied cognitive functioning during intensive nutritional and medical stabilization in patients with severe or extreme AN and investigated associations between weight gain and cognitive improvement. METHODS A few days after admission to a specialized hospital unit, 33 patients with severe or extreme AN, aged 16-42 years, completed assessments of memory, cognitive flexibility, processing speed, and attention. Mean hospitalization was 6 weeks. Patients completed the same assessments at discharge (n = 22) following somatic stabilization and follow-up up to 6 months after discharge (n = 18). RESULTS The patients displayed normal cognitive performance at admission compared to normative data. During nutritional stabilization, body weight increased (mean: 11.3%; range 2.6-22.2%) and memory, attention, and processing speed improved (p values: ≤ 0.0002). No relationship between weight gain and cognitive improvement was observed at discharge or follow-up. CONCLUSIONS Cognitive performance at hospital admission was normal in patients with severe or extreme AN and improved during treatment although without association to weight gain. Based on these results, which are in line with previous studies, patients with severe or extreme AN need not be excluded from cognitively demanding tasks, possibly including psychotherapy. As patients may have other symptoms that interfere with psychotherapy, future research could investigate cognitive functioning in everyday life in patients with severe AN. TRIAL REGISTRATION NUMBER The study is registered at clinicaltrials.gov (NCT02502617). LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark.
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark.
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Open Patient Data Explorative Network (OPEN), Odense, Denmark.
| | - Mia Beck Lichtenstein
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Region of Southern Denmark, Odense, Denmark
| | - Magnus Sjögren
- Institute for Clinical Science, Department of Psychiatry, Umeå University, Umeå, Sweden
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - René Klinkby Støving
- Centre for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
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Lacalaprice D, Mocini E, Frigerio F, Minnetti M, Piciocchi C, Donini LM, Poggiogalle E. Effects of mealtime assistance in the nutritional rehabilitation of eating disorders. Eat Weight Disord 2023; 28:73. [PMID: 37688675 PMCID: PMC10492868 DOI: 10.1007/s40519-023-01605-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). METHODS The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. RESULTS 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. LEVEL OF EVIDENCE Level IV systematic reviews of uncontrolled trials.
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Affiliation(s)
- Doriana Lacalaprice
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Mocini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Francesco Frigerio
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Claudia Piciocchi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Ursumando L, Ponzo V, Monteleone AM, Menghini D, Fucà E, Lazzaro G, Esposito R, Picazio S, Koch G, Zanna V, Vicari S, Costanzo F. The efficacy of non-invasive brain stimulation in the treatment of children and adolescents with Anorexia Nervosa: study protocol of a randomized, double blind, placebo-controlled trial. J Eat Disord 2023; 11:127. [PMID: 37533058 PMCID: PMC10394844 DOI: 10.1186/s40337-023-00852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Current psychological and pharmacological treatments for Anorexia Nervosa (AN) provide only moderate effective support, and there is an urgent need for research to improve therapies, especially in developing age. Non-invasive brain stimulation has suggested to have the potential to reducing AN symptomatology, via targeting brain alterations, such as hyperactivity of right prefrontal cortex (PFC). We suppose that transcranial direct current stimulation (tDCS) to the PFC may be effective in children and adolescents with AN. METHODS We will conduct a randomized, double blind, add-on, placebo-controlled trial to investigate the efficacy of tDCS treatment on clinical improvement. We will also investigate brain mechanisms and biomarkers changes acting in AN after tDCS treatment. Eighty children or adolescent with AN (age range 10-18 years) will undergo treatment-as-usual including psychiatric, nutritional and psychological support, plus tDCS treatment (active or sham) to PFC (F3 anode/F4 cathode), for six weeks, delivered three times a week. Psychological, neurophysiological and physiological measures will be collected at baseline and at the end of treatment. Participants will be followed-up one, three, six months and one year after the end of treatment. Psychological measures will include parent- and self-report questionnaires on AN symptomatology and other psychopathological symptoms. Neurophysiological measures will include transcranial magnetic stimulation (TMS) with electroencephalography and paired pulse TMS and repetitive TMS to investigate changes in PFC connectivity, reactivity and plasticity after treatment. Physiological measures will include changes in the functioning of the endogenous stress response system, body mass index (BMI) and nutritional state. DISCUSSION We expect that tDCS treatment to improve clinical outcome by reducing the symptoms of AN assessed as changes in Eating Disorder Risk composite score of the Eating Disorder Inventory-3. We also expect that at baseline there will be differences between the right and left hemisphere in some electrophysiological measures and that such differences will be reduced after tDCS treatment. Finally, we expect a reduction of endogenous stress response and an improvement in BMI and nutritional status after tDCS treatment. This project would provide scientific foundation for new treatment perspectives in AN in developmental age, as well as insight into brain mechanisms acting in AN and its recovery. Trial registration The study was registered at ClinicalTrials.gov (ID: NCT05674266) and ethical approval for the study was granted by the local research ethics committee (process number 763_OPBG_2014).
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Affiliation(s)
- Luciana Ursumando
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Viviana Ponzo
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Deny Menghini
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Giulia Lazzaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Romina Esposito
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
| | - Silvia Picazio
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
- Department of Psychology, University "Sapienza" of Rome, Rome, Italy
| | - Giacomo Koch
- Experimental Neuropsychophysiology Lab, IRCCS S. Lucia Foundation, Rome, Italy
- Section of Human Phisiology, University of Ferrara, Ferrara, Italy
| | - Valeria Zanna
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
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Chiang CP, Hayes D, Panagiotopoulou E. Apps targeting anorexia nervosa in young people: a systematic review of active ingredients. Transl Behav Med 2023; 13:406-417. [PMID: 36753537 PMCID: PMC10255767 DOI: 10.1093/tbm/ibad003] [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] [Indexed: 02/10/2023] Open
Abstract
Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite the early onset of Anorexia Nervosa (AN) and the increasing use of mobile apps to seek mental healthcare among young people, BCTs underpinning mHealth apps targeting AN have never been systematically examined. This review systematically identified and analyzed BCTs underpinning apps targeted at reducing AN in young people in an attempt to understand their active components. Apps were searched and screened in Apple Store and Google Play. Six apps that met the inclusion criteria and were coded by trained researchers against the BCT Taxonomy V1. Overall, 22 of 93 possible BCTs were identified. The most common were "Information about health consequences," "Social support (unspecified)," and "Information about antecedents". Identified BCTs suggested potential overlaps with traditional clinical treatments for AN, such as cognitive behavioral therapy and family-based therapy. Further investigation is required to evaluate the apps' usability and effectiveness.
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Affiliation(s)
- Clara P Chiang
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
| | - Daniel Hayes
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Evidence Based Practice Unit, UCL and the Anna Freud National Centre for Children and Families (AFNCCF), London, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK
| | - Elena Panagiotopoulou
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
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Levinson CA, Trombley CM, Brosof LC, Williams BM, Hunt RA. Binge Eating, Purging, and Restriction Symptoms: Increasing Accuracy of Prediction Using Machine Learning. Behav Ther 2023; 54:247-259. [PMID: 36858757 DOI: 10.1016/j.beth.2022.08.006] [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: 01/22/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022]
Abstract
Eating disorders are severe mental illnesses characterized by the hallmark behaviors of binge eating, restriction, and purging. These disordered eating behaviors carry extreme impairment and medical complications, regardless of eating disorder diagnosis. Despite the importance of these disordered behaviors to every eating disorder diagnosis, our current models are not able to accurately predict behavior occurrence. The current study utilized machine learning to develop longitudinal predictive models of binge eating, purging, and restriction in an eating disorder sample (N = 60) using real-time intensive longitudinal data. Participants completed four daily assessments of eating disorder symptoms and emotions for 25 days on a smartphone (total data points per participant = 100). Using data, we were able to compute highly accurate prediction models for binge eating, restriction, and purging (.76-.96 accuracy). The ability to accurately predict the occurrence of binge eating, restriction, and purging has crucial implications for the development of preventative interventions for the eating disorders. Machine learning models may be able to accurately predict onset of problematic psychiatric behaviors leading to preventative interventions designed to disrupt engagement in such behaviors.
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Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss the growing body literature emphasizing moderation and harm-reduction in patients with severe and enduring anorexia nervosa (SE-AN)• Outline and discuss the legal, ethical, and medical challenges inpatient providers face when treating patients with SE-AN. ABSTRACT Patients with severe and enduring anorexia nervosa (SE-AN) present numerous clinical and ethical challenges for the hospital psychiatrist. Patients typically come to the hospital in a state of severe medical compromise. Common difficulties in the period of acute medical stabilization include assessment of decision-making capacity and the right to decline treatment, as well as legally complex decisions pertaining to administering artificial nutrition over the patient's objection. Following acute medical stabilization, the psychiatric consultant must decide whether psychiatric hospitalization for continued treatment is indicated, and if so, whether involuntary hospitalization is indicated. The standard of care in these situations is unclear. Pragmatic issues such as lack of appropriate facilities for specialized treatment are common. If involuntary hospitalization is not approved or not pursued, there may be difficulty in determining whether, when, and how to involve palliative care consultants to guide further management. These cases are complex and largely reside in a medico-legal and ethical gray area. This article discusses the difficulties associated with these cases and supports a growing body of literature emphasizing moderation and harm-reduction in patients with SE-AN. Physician-assisted dying (PAD) is also discussed.
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Lindroos A, Nickull S, Tybur JM, Källström M, Nousiainen N, Jern P. The Associations Between Pathogen Disgust Sensitivity, Meat Liking, Plant Liking and a Lifetime Prevalence of Anorexia Nervosa Among Finnish Women. Food Qual Prefer 2023. [DOI: 10.1016/j.foodqual.2023.104822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, McCradden MD. Ethical tensions in the treatment of youth with severe anorexia nervosa. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:69-76. [PMID: 36206789 DOI: 10.1016/s2352-4642(22)00236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022]
Abstract
Treatment of anorexia nervosa poses a moral quandary for clinicians, particularly in paediatrics. The challenges of appropriately individualising treatment while balancing prospective benefits against concomitant harms are best highlighted through exploration and discussion of the ethical issues. The purpose of this Viewpoint is to explore the ethical tensions in treating young patients (around ages 10-18 years) with severe anorexia nervosa who are not capable of making treatment-based decisions and describe how harm reduction can reasonably be applied. We propose the term AN-PLUS to refer to the subset of patients with a particularly concerning clinical presentation-poor quality of life, lack of treatment response, medically severe and unstable, and severe symptomatology-who might benefit from a harm reduction approach. From ethics literature, qualitative studies, and our clinical experience, we identify three core ethical themes in making treatment decisions for young people with AN-PLUS: capacity and autonomy, best interests, and person-centred care. Finally, we consider how a harm reduction approach can provide direction for developing a personalised treatment plan that retains a focus on best interests while attempting to mitigate the harms of involuntary treatment. We conclude with recommendations to operationalise a harm reduction approach in young people with AN-PLUS.
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Affiliation(s)
- Kate Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Health Science Research Program, University of Toronto, Toronto, ON, Canada
| | - Gordon McSheffrey
- Department of Pediatrics, Scarborough Health Network, Toronto, ON, Canada; Child, Youth, Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fleming
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vandana Rawal
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc P Fadel
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Division of Child and Youth Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada.
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Gukasyan N, Schreyer CC, Griffiths RR, Guarda AS. Psychedelic-Assisted Therapy for People with Eating Disorders. Curr Psychiatry Rep 2022; 24:767-775. [PMID: 36374357 DOI: 10.1007/s11920-022-01394-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW A growing body of research suggests psychedelic-assisted therapy (PAT) may be safe and effective for a variety of mental health conditions. Among these, eating disorders have been a recent target of interest. This review provides an up-to-date summary of the potential mechanisms and use of PAT in people diagnosed with eating disorders, with a focus on anorexia nervosa. RECENT FINDINGS Classic psychedelics may have transdiagnostic efficacy through several mechanisms relevant to eating disorder pathology. Interest in, and efforts to increase access to PAT are both high. Early clinical trials are focused on establishing the safety and utility of this treatment in eating disorders, and efficacy remains unclear. High-quality published data to support the use of PAT for people with eating disorders remains lacking. Recent studies however suggest PAT has the potential to augment the efficacy of current interventions for these difficult-to-treat conditions.
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Affiliation(s)
- Natalie Gukasyan
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA
| | - Roland R Griffiths
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, 21287, USA
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13
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Abuhassan M, Anwar T, Fuller-Tyszkiewicz M, Jarman HNK, Shatte A, Liu C, Sukunesan S. Classification of Twitter users with eating disorder engagement: Learning from the biographies. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Efficiency of Transcranial Direct Current Stimulation (tDCS) in Anorexia Nervosa Treatment- Case Report. CURRENT PROBLEMS OF PSYCHIATRY 2022. [DOI: 10.2478/cpp-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation with considerable potential as a treatment for many CNS disorders. Individuals suffering from eating disorders have elevated rates of lifetime depression, anxiety and obsessive-compulsive disorder, also affecting specific brain regions. More studies assess the effect of brain modulation in anorexia nervosa (AN). This study aimed to evaluate the effect, tolerability and safety of tDCS stimulation in the patient with an AN diagnosis.
Material and method: The therapy was implemented in an 18-year-old female hospitalized at the I Department of Psychiatry, Psychotherapy and Early Intervention Medical University of Lublin. The simulation was performed twice daily for 25 minutes for two weeks, 20 sessions. To assess a. anthropometric measures, bioelectrical impedance analysis was conducted; b. biological factors fasting venous blood was drawn; c. psychological aspects: Eating Attitudes Test, Rosenberg self-esteem scale, Beck Depression Inventory, Eating Disorder Examination Questionnaire, Body Esteem Scale, Perceived Stress Scale were used.
Results: The patient responded well to stimulation - apart from a mild headache. After tDCS sessions, improvement in anthropometric measurements, mood, and body self-esteem was observed. No severe changes in blood parameters were observed after the intervention.
Conclusions: Described study case offer preliminary support for achieving meaningful clinical outcomes using transcranial stimulation. However, future clinical studies compared to the placebo group are necessary for proposing a new type of AN therapy.
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15
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Coutinho E, Van Criekinge T, Hanford G, Nathan R, Maden M, Hill R. Music therapy interventions for eating disorders: Lack of robust evidence and recommendations for future research. BRITISH JOURNAL OF MUSIC THERAPY 2022. [DOI: 10.1177/13594575221110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Music therapy (MT) has been used to support people with a variety of eating disorders (EDs), but it is unclear whether there is sufficient and robust evidence from controlled experimental studies. In this article, we report the results of a systematic review that summarises the evidence from published controlled studies where MT has been used to treat people diagnosed with any type of ED. Our results demonstrate that robust evidence concerning the effectiveness of MT for the treatment of EDs is severely lacking. Nonetheless, the evidence described in this paper warrants further investigation especially given that new treatment strategies for EDs are urgently needed. To this end, we offer a set of recommendations for future high-quality experimental studies that can inform the development of effective MT interventions and support for people with EDs.
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Affiliation(s)
| | | | | | - Rajan Nathan
- Cheshire and Wirral Partnership NHS Foundation Trust, UK
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16
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Guarda AS, Hanson A, Mehler P, Westmoreland P. Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined. J Eat Disord 2022; 10:79. [PMID: 35672780 PMCID: PMC9175496 DOI: 10.1186/s40337-022-00599-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
A recent article (JED 10:23, 2022) proposed defining terminal anorexia to improve access to palliative and hospice care, and to medical aid in dying for a minority of patients with severe and enduring anorexia nervosa (SE-AN). The authors presented three cases and, for two, the first author participated in their death. Anorexia nervosa is a treatable psychiatric condition for which recovery may be uncertain. We are greatly concerned however regarding implications of applying the label "terminal" to anorexia nervosa and the risk it will lead to unjustified deaths in individuals whose mental illness impairs their capacity to make a reasoned treatment decision.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
| | - Annette Hanson
- Department of Psychiatry, University of Maryland, Jessup, MD, 20794, USA
| | - Philip Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patricia Westmoreland
- Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, 80045, USA
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17
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Hemmingsen SD, Jensen NA, Larsen PV, Sjögren JM, Lichtenstein MB, Støving RK. Cortisol, Depression, and Anxiety Levels Before and After Short-Term Intensive Nutritional Stabilization in Patients With Severe Anorexia Nervosa. Front Psychiatry 2022; 13:939225. [PMID: 35903636 PMCID: PMC9314772 DOI: 10.3389/fpsyt.2022.939225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Depression and anxiety are well-known comorbid conditions in patients with anorexia nervosa (AN). Hypercortisolemia in patients with AN may be pathogenic and contribute to depression and anxiety symptomatology. OBJECTIVE The aim of this study was to investigate short-term changes in cortisol levels and depression and anxiety symptomatology following intensive re-nutrition in patients with severe AN and hospitalized in a specialized unit. Furthermore, we investigated the potential association between cortisol levels and psychometric parameters. METHODS A total of 36 patients with AN were enrolled in the study. Nine dropped out before follow-up. Patients underwent paraclinical and psychometric examinations at admission and discharge. Measurements included plasma cortisol, cortisol binding globulin (CBG), 24-h urine cortisol, and self-report questionnaires regarding eating disorder, depression, anxiety, and stress symptoms. Patients were hospitalized in the unit for somatic stabilization and intensive re-nutrition. Mean admission length was 41 days. The study was registered at ClinicalTrials.gov (NCT02502617). RESULTS Cortisol levels in blood and urine did not change from admission to discharge in patients with severe AN. Symptoms of depression, anxiety, stress, and eating disorder remained elevated at discharge. There were no associations between changes in cortisol levels and changes in psychometrics. DISCUSSION Our results suggest that short-term intensive re-nutrition did not alter hypothalamic-pituitary-adrenal axis activity or mental health in patients with severe AN. Long-term stabilization and longer follow-up after hospital discharge may be needed to detect changes in cortisol levels and whether these changes are associated with depression and anxiety symptomatology. Greater knowledge about cortisol levels and mental health in patients with severe AN may help in the development of new treatment choices for the chronically ill patients. Future studies could investigate whether cortisol-lowering drugs have a therapeutic effect on mental health in AN.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Center for Eating Disorders, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Research Unit for Medical Endocrinology, Department of Clinical Research, Open Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Nikolai Arndal Jensen
- Center for Eating Disorders, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Research Unit for Medical Endocrinology, Department of Clinical Research, Open Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Jan Magnus Sjögren
- Psychiatric Center Ballerup, Copenhagen, Denmark.,Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Region of Southern Denmark, Vejle, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - René Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Research Unit for Medical Endocrinology, Department of Clinical Research, Open Patient Data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
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18
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De Vloo P, Lam E, Elias GJ, Boutet A, Sutandar K, Giacobbe P, Woodside DB, Lipsman N, Lozano A. Long-term follow-up of deep brain stimulation for anorexia nervosa. J Neurol Neurosurg Psychiatry 2021; 92:1135-1136. [PMID: 33687970 DOI: 10.1136/jnnp-2020-325711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Philippe De Vloo
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada .,Department of Neurosurgery, KU Leuven, Leuven, Belgium
| | - Eileen Lam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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19
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Lin JA, Jhe G, Vitagliano JA, Milliren CE, Spigel R, Woods ER, Forman SF, Richmond TK. The Association of Malnutrition, illness duration, and pre-morbid weight status with anxiety and depression symptoms in adolescents and young adults with restrictive eating disorders: a cross-sectional study. J Eat Disord 2021; 9:60. [PMID: 34001260 PMCID: PMC8127488 DOI: 10.1186/s40337-021-00415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Restrictive eating disorders (EDs) are often comorbid with anxiety and depression symptoms, placing patients at risk for more severe disease, worse treatment outcomes, and higher rates of mortality. To identify risks for developing such co-morbidities, we assessed the association of malnutrition, ED illness duration, and pre-morbid weight status with symptoms of anxiety and depression in adolescents/young adults (AYAs) with EDs. METHODS 145 participants with restrictive EDs (anorexia nervosa [AN], other specified feeding and eating disorders [OSFED], avoidant restrictive food intake disorder [ARFID]) were included from the RECOVERY study, a longitudinal web-based registry of AYAs with EDs. We measured malnutrition as percent of expected body mass index (%eBMI), based on participants' pre-morbid growth trajectory. Outcomes were anxiety and depression scores from the Generalized Anxiety Disorder 7-item (GAD-7) and Center for Epidemiologic Studies Depression (CES-D) scales. We used multiple linear regression to examine the association of malnutrition, ED duration, and pre-morbid weight status with symptoms of anxiety and depression. RESULTS Mean (SD) age was 16.4(3.0) years; 87% were female; 89% white; 85% had AN, 6% OSFED, 10% ARFID. Of these, 2/3 had ED symptoms ≥1 year, 1/3 had previous higher level of ED care (HLOC), and half were taking psychiatric medications. Mean %eBMI was 90% (range 57-112%). Mean GAD-7 was 9.4(5.9) and CES-D was 24(13.8), indicating most participants had clinically significant anxiety and/or depression. Degree of malnutrition was not significantly associated with anxiety or depression adjusting for age, sex, sexual orientation, ED diagnosis, and use of psychiatric medication. Those with longer duration of ED symptoms had higher depression scores after adjusting for malnutrition, HLOC, length of ED symptoms, and time in our care (p = 0.038). Patients with pre-morbid BMIs ≥75th percentile had lower depression scores than those with pre-morbid BMIs <75th percentile (p = 0.014). CONCLUSIONS We find high degree of clinically relevant anxiety and depression symptoms in a population of AYAs with EDs. Our findings suggest that factors beyond malnutrition play a role in the co-morbid mood and anxiety disorders in this population. Overall, rapid ED diagnosis and comprehensive treatment for patients with EDs across the weight spectrum-and especially those with psychiatric co-morbidities-will likely aid in recovery.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Grace Jhe
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Julia A Vitagliano
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Rebecca Spigel
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Tracy K Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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20
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Krukowska-Zaorska A, Kot K, Marek E, Dura W, Safranow K, Lipski M. Knowledge of Oral and Physical Manifestations of Anorexia Nervosa Among Polish Dentists: A Cross-Sectional Study. Front Psychiatry 2021; 12:751564. [PMID: 34777055 PMCID: PMC8578852 DOI: 10.3389/fpsyt.2021.751564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland. Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used. Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa. Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.
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Affiliation(s)
- Agnieszka Krukowska-Zaorska
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kot
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Marek
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Włodzimierz Dura
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Mariusz Lipski
- Department of Preclinical Conservative Dentistry and Preclinical Endodontics, Pomeranian Medical University, Szczecin, Poland
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21
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Le LKD, Mihalopoulos C, Engel L, Touyz S, González-Chica DA, Stocks N, Hay P. Burden and health state utility values of eating disorders: results from a population-based survey. Psychol Med 2021; 51:130-137. [PMID: 31670627 DOI: 10.1017/s0033291719003064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND There are no published estimates of the health state utility values (HSUVs) for a broad range of eating disorders (EDs). HSUVs are used in economic evaluations to determine quality-adjusted life years or as a measure of disorder burden. The main objective of the current study is to present HSUVs for a broad range of EDs based on DSM-5 diagnoses. METHODS We used pooled data of two Health Omnibus Surveys (2015 and 2016) including representative samples of individuals aged 15 + years living in South Australia. HSUVs were derived from the SF-6D (based on the SF-12 health-related quality of life questionnaire) and analysed by ED classification, ED symptoms (frequency of binge-eating or distress associated to binge eating) and weight status. Multiple linear regression models, adjusted for socio-demographics, were used to test the differences of HSUVs across ED groups. RESULTS Overall, 18% of the 5609 individuals met criteria for ED threshold and subthreshold. EDs were associated with HSUV decrements, especially if they were severe disorders (compared to non-ED), binge ED: -0.16 (95% CI -0.19 to -0.13), bulimia nervosa: -0.12, (95% CI -0.16 to -0.08). There was an inverse relationship between distress related binge eating and HSUVs. HSUVs were lower among people with overweight/obese compared to those with healthy weight regardless of ED diagnosis. CONCLUSIONS EDs were significantly associated with lower HSUVs compared to people without such disorders. This study, therefore, provides new insights into the burden of EDs. The derived HSUVs can also be used to populate future economic models.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Lidia Engel
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, the University of Sydney, Camperdown, New South Wales, Australia
| | - David Alejandro González-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
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22
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Redgrave GW, Schreyer CC, Coughlin JW, Fischer LK, Pletch A, Guarda AS. Discharge Body Mass Index, Not Illness Chronicity, Predicts 6-Month Weight Outcome in Patients Hospitalized With Anorexia Nervosa. Front Psychiatry 2021; 12:641861. [PMID: 33716836 PMCID: PMC7946839 DOI: 10.3389/fpsyt.2021.641861] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
Proposed treatments for severe and enduring anorexia nervosa (SE-AN) focus on quality of life, and psychological and social functioning. By de-emphasizing weight restoration as a priority, however, premature diagnosis of SE-AN may reduce potential for recovery. The present study assessed the effect of weight restoration, illness duration, and severity on treatment outcome 6 months after discharge from an intensive, meal-based behavioral treatment program. Participants included hospitalized adult women (N = 191) with AN or underweight other specified feeding and eating disorder (OSFED). Participants were characterized as short-term (ill <7 years; n = 74) or long-term ill (ill ≥ 7 years; n = 117). Compared with short-term ill, long-term ill patients were older, had lower lifetime body mass index (BMI), more prior admissions, and exhibited greater depression and neuroticism. Long-term vs. short-term ill patients gained weight at the same rate (~2 kg/wk) and were equally likely to be weight restored by discharge (>75% reached BMI ≥ 19 kg/m2 in both groups). At 6-month follow-up (n = 99), both groups had equivalent self-reported BMI, and depression, drive for thinness, body dissatisfaction, and bulimia scores. The only predictor of BMI ≥ 19 kg/m2 at follow-up was discharge BMI. The likelihood of a BMI ≥ 19 kg/m2 at follow-up was 5-fold higher for those with discharge BMI ≥ 19 kg/m2. Few studies of long-term ill inpatients with AN have examined the impact of full weight restoration on short-term outcomes. This study supports the therapeutically optimistic stance that, regardless of illness duration, hospitalized patients with AN benefit from gaining weight to a BMI ≥ 19 kg/m2.
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Affiliation(s)
- Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laura K Fischer
- Children's National Medical Center, Clinical and Translational Science Institute, Washington, DC, United States
| | - Allisyn Pletch
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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23
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Hemmingsen SD, Wesselhoeft R, Lichtenstein MB, Sjögren JM, Støving RK. Cognitive improvement following weight gain in patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2020; 29:402-426. [PMID: 33044043 DOI: 10.1002/erv.2796] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) has been associated with cognitive impairment. While re-nutrition is one of the main treatment targets, the effect on cognitive impairments is unclear. The aim of this review was to examine whether cognitive functions improve after weight gain in patients with AN. METHOD A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guidelines (PROSPERO CRD42019081993). Literature searches were conducted May 20th , 2019 in PubMed, EMBASE, PsychINFO and Cochrane Library. Pairs of reviewers screened reports independently based on titles/abstracts (N = 6539) and full texts (N = 378). Furthermore, they assessed the quality of reports, including whether practice effects were accounted for. RESULTS Twenty-four longitudinal reports were included featuring 757 patients and 419 healthy controls. Six studies examined children and adolescents. Four out of four studies found processing speed to improve above and beyond what could be assigned to practice effects and three out of four studies found that cognitive flexibility was unaffected after weight gain in children and adolescents. Results from studies of adults were inconclusive. DISCUSSION The literature on cognitive change in patients with AN following weight gain is sparse. Preliminary conclusions can be made only for children and adolescents, where weight gain appeared to be associated with improved processing speed.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorder, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
| | - Rikke Wesselhoeft
- Clinical Pharmacology and Pharmacy, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Aabenraa, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Jan Magnus Sjögren
- Eating Disorder Unit, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Klinkby Støving
- Centre for Eating Disorder, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network (OPEN), Odense, Denmark
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24
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Hemmingsen SD, Lichtenstein MB, Hussain AA, Sjögren JM, Støving RK. Case report: cognitive performance in an extreme case of anorexia nervosa with a body mass index of 7.7. BMC Psychiatry 2020; 20:284. [PMID: 32503476 PMCID: PMC7275539 DOI: 10.1186/s12888-020-02701-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/28/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Studies show that adult patients with anorexia nervosa display cognitive impairments. These impairments may be caused by illness-related circumstances such as low weight. However, the question is whether there is a cognitive adaptation to enduring undernutrition in anorexia nervosa. To our knowledge, cognitive performance has not been assessed previously in a patient with anorexia nervosa with a body mass index as low as 7.7 kg/m2. CASE PRESENTATION We present the cognitive profile of a 35-year-old woman with severe and enduring anorexia nervosa who was diagnosed at the age of 10 years. She was assessed with a broad neuropsychological test battery three times during a year. Her body mass index was 8.4, 9.3, and 7.7 kg/m2, respectively. Her general memory performance was above the normal range and she performed well on verbal and design fluency tasks. Her working memory and processing speed were within the normal range. However, her results on cognitive flexibility tasks (set-shifting) were below the normal range. CONCLUSIONS The case study suggests that it is possible to perform normally cognitively despite extreme and chronic malnutrition though set-shifting ability may be affected. This opens for discussion whether patients with anorexia nervosa can maintain neuropsychological performance in spite of extreme underweight and starvation. TRIAL REGISTRATION ClinicalTrials.gov, NCT02502617. Registered 20 July 2015.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorder, Odense University Hospital, Odense, Denmark. .,Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Open Patient data Explorative Network (OPEN), Odense, Denmark. .,The Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alia Arif Hussain
- grid.466916.a0000 0004 0631 4836Eating Disorder Unit, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Magnus Sjögren
- grid.466916.a0000 0004 0631 4836Eating Disorder Unit, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Klinkby Støving
- grid.7143.10000 0004 0512 5013Centre for Eating Disorder, Odense University Hospital, Odense, Denmark ,grid.7143.10000 0004 0512 5013Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,Open Patient data Explorative Network (OPEN), Odense, Denmark ,The Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Voderholzer U, de Zwaan M, Löwe B, Schulze U, Herpertz-Dahlmann B. Transition von Adoleszenten mit Essstörungen in das Erwachsenenalter: Das Positionspapier der Task-Force Transitionspsychiatrie der DGKJP und DGPPN. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:443-447. [PMID: 32469257 DOI: 10.1024/1422-4917/a000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ulrich Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee / Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität, München
| | - Martina de Zwaan
- Medizinische Hochschule Hannover Klinik für Psychosomatik und Psychotherapie, Hannover
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26
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Braude MR, Con D, Clayton‐Chubb D, Nandurkar R, Chua L, Newnham ED. Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care. Intern Med J 2020; 50:77-85. [DOI: 10.1111/imj.14329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Michael R. Braude
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Danny Con
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Daniel Clayton‐Chubb
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
| | - Ruchira Nandurkar
- Department of General Medicine, Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
| | - Ling‐Ern Chua
- Department of PsychiatryEastern Health Melbourne Victoria Australia
| | - Evan D. Newnham
- Department of Gastroenterology and HepatologyMonash University Melbourne Victoria Australia
- Department of General Medicine, Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
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27
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Hughes EK, Poker S, Bortz A, Yeo M, Telfer M, Sawyer SM. Adolescent and Parent Experience of Care at a Family-Based Treatment Service for Eating Disorders. Front Psychiatry 2020; 11:310. [PMID: 32372986 PMCID: PMC7186319 DOI: 10.3389/fpsyt.2020.00310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Incorporating consumer perspectives is an important but often overlooked opportunity to optimize treatment engagement and outcomes for adolescents with eating disorders. This study explored the experience of care of adolescents and their parents at a multidisciplinary specialist eating disorders service providing family-based treatment (FBT) as first-line treatment. METHOD Eighty-five adolescents and 145 parents who completed FBT at the service between 2013 and 2015 were surveyed in 2017 about their experience of care. A study-designed survey asked respondents to rate on Likert scales their experience of service access, intake assessment, education, support, interactions with the treatment team, recovery, and the discharge process. Open-ended comments on helpful and unhelpful aspects of the service provided further context on the ratings. RESULTS Overall families were very positive about their experience, particularly in regard to assessment, education, interactions with the team, and achieving physical health. Although parents tended to be more satisfied, adolescents also held the service in high regard. Some areas were identified that could be improved, including treatment delays, carer support, therapeutic alliance, and preparation for discharge. CONCLUSIONS Surveying families about their experience of care provides an important opportunity to identify service strengths as well as services gaps. The results indicated several areas that specialist eating disorder services could focus on to ensure that the services provided, including FBT, fully meet the needs of families and optimize adolescents' treatment experiences.
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Affiliation(s)
- Elizabeth K Hughes
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Suzannah Poker
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Amy Bortz
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michele Yeo
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michelle Telfer
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Susan M Sawyer
- Department of Pediatrics, University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
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28
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Paquin Hodge C, Gauvin L, St-Hilaire A, Israel M, Azzi M, Kahan E, Thaler L, Dansereau E, Steiger H. A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome? Int J Eat Disord 2019; 52:1015-1023. [PMID: 31408212 DOI: 10.1002/eat.23150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight-restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. METHOD We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post-treatment follow-up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32, and we measured height and weight to compute body mass index. RESULTS Multilevel modeling analyses that controlled for time in treatment and time in follow-up indicated the two protocols yielded equivalent in-treatment gains and post-treatment loss of gains. DISCUSSION Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.
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Affiliation(s)
- Chloé Paquin Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal and École de santé publique de l'Université de Montréal, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Michelle Azzi
- Psychiatry Department, McGill University, Montreal, Canada.,Psychology Department, McGill University, Montreal, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Eve Dansereau
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
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29
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Dimitropoulos G, Landers AL, Freeman V, Novick J, Cullen O, Le Grange D. Family-based treatment for transition age youth: the role of expressed emotion and general family functioning. Eat Disord 2019; 27:419-435. [PMID: 30358513 DOI: 10.1080/10640266.2018.1529472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.
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Affiliation(s)
- Gina Dimitropoulos
- Toronto General Hospital Eating Disorder Program, University Health Network , Toronto , Ontario , Canada
| | - Ashley L Landers
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University , Falls Church , Virginia , USA
| | - Victoria Freeman
- Toronto General Hospital, University Health Network , Toronto Ontario , Canada
| | - Jason Novick
- Department of Sociology, Mount Royal University , Calgary Alberta , Canada
| | - Olivia Cullen
- Faculty of Social Work, University of Calgary , Calgary Alberta , Canada
| | - Daniel Le Grange
- Department of Psychiatry, University of California , San Francisco CA , USA
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30
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Himmerich H, Bentley J, Lichtblau N, Brennan C, Au K. Facets of shared decision-making on drug treatment for adults with an eating disorder. Int Rev Psychiatry 2019; 31:332-346. [PMID: 30870048 DOI: 10.1080/09540261.2019.1571995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Shared decision-making (SDM) means that clinicians and the patient make decisions about the treatment together. Regarding drug treatment in eating disorders (EDs), such decisions may include psychopharmacological treatment for the ED itself, medications for potential co-morbid psychiatric disorders, pharmacological strategies to alleviate the health consequences of an ED, or 'pro re nata' (PRN) medication which is given in acute care when required. Decisions regarding drug treatment in EDs should be specific in terms of the active pharmacological substance, its dose, its route of administration, and the duration of treatment. Decisions should be made with regard to the specific health risks of patients with EDs and the entire treatment approach, and should take alternative measures, additional therapies, and specific combinations of therapies into account. The differences in the expectations of patients, carers, and clinicians towards drug treatment, the lack of specific suggestions in clinical practice guidelines, and the lack of approved psychopharmacological treatment options make SDM necessary, but also a challenge. However, SDM may be limited due to the patient's impaired insight or limited capacity due to the ED. Thus, the legal framework must be taken into consideration.
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Affiliation(s)
- Hubertus Himmerich
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK.,b Department of Psychological Medicine , IoPPN, King's College London , London , UK
| | - Jessica Bentley
- b Department of Psychological Medicine , IoPPN, King's College London , London , UK
| | | | - Clare Brennan
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK
| | - Katie Au
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK
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31
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Vaughn DA, Kerr WT, Moody TD, Cheng GK, Morfini F, Zhang A, Leow AD, Strober MA, Cohen MS, Feusner JD. Differentiating weight-restored anorexia nervosa and body dysmorphic disorder using neuroimaging and psychometric markers. PLoS One 2019; 14:e0213974. [PMID: 31059514 PMCID: PMC6502309 DOI: 10.1371/journal.pone.0213974] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are potentially life-threatening conditions whose partially overlapping phenomenology—distorted perception of appearance, obsessions/compulsions, and limited insight—can make diagnostic distinction difficult in some cases. Accurate diagnosis is crucial, as the effective treatments for AN and BDD differ. To improve diagnostic accuracy and clarify the contributions of each of the multiple underlying factors, we developed a two-stage machine learning model that uses multimodal, neurobiology-based, and symptom-based quantitative data as features: task-based functional magnetic resonance imaging data using body visual stimuli, graph theory metrics of white matter connectivity from diffusor tensor imaging, and anxiety, depression, and insight psychometric scores. In a sample of unmedicated adults with BDD (n = 29), unmedicated adults with weight-restored AN (n = 24), and healthy controls (n = 31), the resulting model labeled individuals with an accuracy of 76%, significantly better than the chance accuracy of 35% ( p^<10‑4). In the multivariate model, reduced white matter global efficiency and better insight were associated more with AN than with BDD. These results improve our understanding of the relative contributions of the neurobiological characteristics and symptoms of these disorders. Moreover, this approach has the potential to aid clinicians in diagnosis, thereby leading to more tailored therapy.
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Affiliation(s)
- Don A. Vaughn
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - Wesley T. Kerr
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Biomathematics, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Internal Medicine, Eisenhower Medical Center, Rancho Mirage, California, United States of America
| | - Teena D. Moody
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Gigi K. Cheng
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
| | - Francesca Morfini
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Aifeng Zhang
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Alex D. Leow
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Michael A. Strober
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
| | - Mark S. Cohen
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- Departments of Neurology, Radiology, Biomedical Physics, Psychology, Bioengineering and California Nanosystems Institute, University of California Los Angeles, Los Angeles, California, United States of America
| | - Jamie D. Feusner
- Department of Psychology, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
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32
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Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features. J Eat Disord 2019; 7:28. [PMID: 31463050 PMCID: PMC6706937 DOI: 10.1186/s40337-019-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress. METHOD Data were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10). RESULTS On the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others. CONCLUSIONS Results indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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Breithaupt L, Eickman L, Byrne CE, Fischer S. REbeL peer education: A model of a voluntary, after-school program for eating disorder prevention. Eat Behav 2019; 32:111-116. [PMID: 27825587 DOI: 10.1016/j.eatbeh.2016.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in the pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.
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Affiliation(s)
- Lauren Breithaupt
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States; REbeL, Inc. 12980 Metcalf, Suite 325, Overland Park, KS 66213, United States.
| | - Laura Eickman
- REbeL, Inc. 12980 Metcalf, Suite 325, Overland Park, KS 66213, United States
| | - Catherine E Byrne
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States
| | - Sarah Fischer
- George Mason University, Department of Psychology, 4400 University Drive, 3F5, Fairfax, VA 22030, United States
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Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLoS One 2018; 13:e0202330. [PMID: 30114286 PMCID: PMC6095578 DOI: 10.1371/journal.pone.0202330] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 08/01/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE In on-line forums, parents have reported that their children seemed to experience a sudden or rapid onset of gender dysphoria, appearing for the first time during puberty or even after its completion. Parents describe that the onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity. Recently, clinicians have reported that post-puberty presentations of gender dysphoria in natal females that appear to be rapid in onset is a phenomenon that they are seeing more and more in their clinic. Academics have raised questions about the role of social media in the development of gender dysphoria. The purpose of this study was to collect data about parents’ observations, experiences, and perspectives about their adolescent and young adult (AYA) children showing signs of an apparent sudden or rapid onset of gender dysphoria that began during or after puberty, and develop hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among this demographic group. METHODS For this descriptive, exploratory study, recruitment information with a link to a 90-question survey, consisting of multiple-choice, Likert-type and open-ended questions was placed on three websites where parents had reported sudden or rapid onsets of gender dysphoria occurring in their teen or young adult children. The study’s eligibility criteria included parental response that their child had a sudden or rapid onset of gender dysphoria and parental indication that their child’s gender dysphoria began during or after puberty. To maximize the chances of finding cases meeting eligibility criteria, the three websites (4thwavenow, transgender trend, and youthtranscriticalprofessionals) were selected for targeted recruitment. Website moderators and potential participants were encouraged to share the recruitment information and link to the survey with any individuals or communities that they thought might include eligible participants to expand the reach of the project through snowball sampling techniques. Data were collected anonymously via SurveyMonkey. Quantitative findings are presented as frequencies, percentages, ranges, means and/or medians. Open-ended responses from two questions were targeted for qualitative analysis of themes. RESULTS There were 256 parent-completed surveys that met study criteria. The AYA children described were predominantly natal female (82.8%) with a mean age of 16.4 years at the time of survey completion and a mean age of 15.2 when they announced a transgender-identification. Per parent report, 41% of the AYAs had expressed a non-heterosexual sexual orientation before identifying as transgender. Many (62.5%) of the AYAs had reportedly been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria (range of the number of pre-existing diagnoses 0–7). In 36.8% of the friendship groups described, parent participants indicated that the majority of the members became transgender-identified. Parents reported subjective declines in their AYAs’ mental health (47.2%) and in parent-child relationships (57.3%) since the AYA “came out” and that AYAs expressed a range of behaviors that included: expressing distrust of non-transgender people (22.7%); stopping spending time with non-transgender friends (25.0%); trying to isolate themselves from their families (49.4%), and only trusting information about gender dysphoria from transgender sources (46.6%). Most (86.7%) of the parents reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar timeframe, or both. CONCLUSION This descriptive, exploratory study of parent reports provides valuable detailed information that allows for the generation of hypotheses about factors that may contribute to the onset and/or expression of gender dysphoria among AYAs. Emerging hypotheses include the possibility of a potential new subcategory of gender dysphoria (referred to as rapid-onset gender dysphoria) that has not yet been clinically validated and the possibility of social influences and maladaptive coping mechanisms. Parent-child conflict may also explain some of the findings. More research that includes data collection from AYAs, parents, clinicians and third party informants is needed to further explore the roles of social influence, maladaptive coping mechanisms, parental approaches, and family dynamics in the development and duration of gender dysphoria in adolescents and young adults.
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Affiliation(s)
- Lisa Littman
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- * E-mail:
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35
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Costanzo F, Menghini D, Maritato A, Castiglioni MC, Mereu A, Varuzza C, Zanna V, Vicari S. New Treatment Perspectives in Adolescents With Anorexia Nervosa: The Efficacy of Non-invasive Brain-Directed Treatment. Front Behav Neurosci 2018; 12:133. [PMID: 30083095 PMCID: PMC6064943 DOI: 10.3389/fnbeh.2018.00133] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/13/2018] [Indexed: 01/29/2023] Open
Abstract
Poor treatment outcomes are available for anorexia nervosa (AN) and treatment innovations are urgently needed. Recently, non-invasive neuromodulation tools have suggested to have potential for reducing an symptomatology targeting brain alterations. The objective of the study was to verify whether left anodal/right cathodal prefrontal cortex transcranial direct current stimulation (tDCS), may aid in altering/resetting inter-hemispheric balance in patients with AN, re-establishing control over eating behaviors. Twenty-three adolescents with an underwent a treatment as usual (AU), including nutritional, pharmacological, and psychoeducational treatment, plus 18 sessions of tDCS (TDCS+AU = n11; mean age = 13.9, SD = 1.8 years) or a family based therapy (FBT+AU = n12, mean age = 15.1, SD = 1.5 years). Psychopathological scales and the body mass index (BMI) were assessed before and after treatment. After 6 weeks of treatment, the BMI values increased only in the tDCS group, even at 1-month follow-up. Independently of the treatment, all participants improved in several psychopathological measures, included AN psychopathology and mood and anxiety symptoms. Our results demonstrated for the first time a specific effect of the left anodal/right cathodal tDCS treatment protocol on stable weight gain and a superiority compared to an active control treatment for adolescents with AN. Results were interpreted as a possible direct/indirect effect of tDCS in into some pathophysiological mechanisms of AN, involving the mesocortical dopaminergic pathways and the promotion of food intake. This pilot study opens new perspectives in the treatment of an in adolescence, supporting the targeted and beneficial effects of a brain-based treatment.
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Affiliation(s)
- Floriana Costanzo
- Child Neuropsychiatric Unit, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
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36
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De Cuyper K, Hermans D, Pieters G, Claes L, Vansteelandt K. Indirect and direct measures of striving for perfection moderate body mass index curves in the intensive treatment of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 27:86-96. [PMID: 30009415 DOI: 10.1002/erv.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/11/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Kathleen De Cuyper
- University Psychiatric Center KU Leuven, Leuven, Belgium.,KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Dirk Hermans
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Guido Pieters
- KU Leuven Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Laurence Claes
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040797. [PMID: 29671779 PMCID: PMC5923839 DOI: 10.3390/ijerph15040797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/05/2018] [Accepted: 04/17/2018] [Indexed: 11/18/2022]
Abstract
When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.
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Matthews A, Lenz KR, Peugh J, Copps EC, Peterson CM. Caregiver burden and illness perceptions in caregivers of medically hospitalized youth with anorexia nervosa. Eat Behav 2018; 29:14-18. [PMID: 29413819 DOI: 10.1016/j.eatbeh.2018.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 12/31/2022]
Abstract
Caregiver burden is common in caregivers of youth with anorexia nervosa (AN) and could impede the successful implementation of family-based therapy (FBT). Thus, it is important to better understand mechanisms by which caregiver burden is developed and maintained. This study aimed to examine the relation between caregiver illness perceptions about AN, symptom severity indicators, and caregiver burden in a sample of medically hospitalized youth with AN. Fifty-one youth with AN (N = 34) or Atypical AN (AAN; N = 17; mean age = 14.85, SD = 1.41; 76% female) and their primary caregivers (N = 47 mothers and N = 4 fathers) completed self-report questionnaires at hospital admission. Collected data included caregiver and youth illness perceptions about AN, caregiver burden, and youth self-reports of psychological symptoms. Physiological data regarding symptom severity included admitting percent of expected body weight (%EBW) and minimum heart rate during admission. Findings indicated that caregiver beliefs about negative consequences of AN were associated with caregiver burden, independent of youth age, sex, illness duration, and diagnosis. Youth reports of symptom severity, %EBW, and low heart rate were not associated with increased caregiver burden. Findings suggest that the subjective experience of having a youth with AN are a greater determinant of caregiver burden than objective indicators of illness severity. Further, these findings provide support for the FBT clinician to strike a balance between providing information about the potential consequences of AN, while instilling hope for recovery and bolstering parent self-efficacy.
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Affiliation(s)
- Abigail Matthews
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, United States.
| | - Katrina R Lenz
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, United States
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, United States
| | - Emily C Copps
- Xavier University, School of Psychology, United States
| | - Claire M Peterson
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, United States
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Levinson CA, Sala M, Fewell L, Brosof LC, Fournier L, Lenze EJ. Meal and snack-time eating disorder cognitions predict eating disorder behaviors and vice versa in a treatment seeking sample: A mobile technology based ecological momentary assessment study. Behav Res Ther 2018; 105:36-42. [PMID: 29614379 DOI: 10.1016/j.brat.2018.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 01/01/2023]
Abstract
Individuals with eating disorders experience high anxiety when eating, which may contribute to the high relapse rates seen in the eating disorders. However, it is unknown if specific cognitions associated with such anxiety (e.g., fears of gaining weight) may lead to engagement in eating disorder behaviors (e.g., weighing oneself). Participants (N = 66) recently treated at a residential eating disorder facility and diagnosed with an eating disorder (primarily anorexia nervosa; n = 40; 60.6%) utilized a mobile application to answer questions about mealtime cognitions, anxiety, and eating disorder behaviors four times a day for one week. Hierarchical linear models using cross-lag analyses identified that there were quasi-causal (and sometimes reciprocal) within-person relationships between specific eating disorder cognitions and subsequent eating disorder behaviors. These cognitions predicted higher anxiety during the next meal and eating disorder pathology at one-month follow-up. Interventions personalized to target these specific cognitions in real time might reduce eating disorder relapse.
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Affiliation(s)
- Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, USA.
| | - Margarita Sala
- Southern Methodist University, Department of Psychology, USA
| | - Laura Fewell
- University of Louisville, Department of Psychological & Brain Sciences, USA
| | - Leigh C Brosof
- University of Louisville, Department of Psychological & Brain Sciences, USA
| | - Lauren Fournier
- Washington University in St. Louis, Department of Psychological & Brain Sciences, USA
| | - Eric J Lenze
- Washington University in St. Louis, Department of Psychiatry, USA
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40
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Innes NT, Clough BA, Day JJ, Casey LM. Can the Perceived Barriers to Psychological Treatment Scale be used to investigate treatment barriers among females with disordered and non-disordered eating behaviours? Psychiatry Res 2018; 259:68-76. [PMID: 29031166 DOI: 10.1016/j.psychres.2017.09.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/01/2017] [Accepted: 09/24/2017] [Indexed: 01/09/2023]
Abstract
There is a lack of psychometrically sound instruments to assess treatment barriers among individuals with disordered eating behaviours. This study examined the factor structure and psychometric properties of the Perceived Barriers to Psychological Treatment scale (PBPT; Mohr et al., 2010) among a sample of individuals with disordered eating behaviours. Participants were 708 females aged 14 years and older who completed an online survey. The sample was randomly divided in two for the conduct of exploratory (EFA) and confirmatory (CFA) factor analyses. EFA suggested a seven-factor structure retaining 24 of the original 27 items (variance explained = 60%, α = 0.91). Factors were stigma, participation restrictions, negative evaluation of treatment, lack of motivation, emotional concerns, access restrictions, and time constraints. To assess clinical sensitivity, we conducted a secondary EFA utilising only clinical cases from this sample, which supported the solution but suggested retaining 25 of the original 27 items (variance explained = 58%, α = 0.89). The 25-item, seven-factor solution was further supported by CFA with an independent sample. Construct validity was also supported. The study suggests that the instrument will provide clinicians and researchers with a valid and reliable method of assessing treatment barriers in disordered eating samples.
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Affiliation(s)
- Natasha T Innes
- School of Applied Psychology, Griffith University, Menzies Health Institute Queensland, Australia
| | - Bonnie A Clough
- School of Applied Psychology, Griffith University, Menzies Health Institute Queensland, Australia; School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Australia
| | - Jamin J Day
- School of Psychology and Counselling, Institute for Resilient Regions, University of Southern Queensland, Australia
| | - Leanne M Casey
- School of Applied Psychology, Griffith University, Menzies Health Institute Queensland, Australia.
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Abstract
INTRODUCTION Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) are the primary eating disorders (EDs). The only psychopharmacological treatment options for EDs with approval in some countries include fluoxetine for BN and lisdexamfetamine for BED. Given the high comorbidity and genetic correlations with other psychiatric disorders, it seems possible that novel medications for these conditions might also be effective in EDs. Areas covered: The current scientific literature has increased our understanding of how medication could be beneficial for patients with EDs on a molecular, functional and behavioral level. On the basis of theoretical considerations about neurotransmitters, hormones and neural circuits, possible drug targets for the treatment of EDs may include signal molecules and receptors of the self-regulatory system such as serotonin, norepinephrine and glutamate, the hedonic system including opioids, cannabinoids and dopamine and the hypothalamic homeostatic system including histamine, ghrelin, leptin, insulin, and glucagon-like peptide-1. Expert commentary: The latest research points to an involvement of both the immune and the metabolic systems in the pathophysiology of EDs and highlights the importance of the microbiome. Therefore, the next few years may unveil drug targets for EDs not just inside and outside of the brain, but possibly even outside of the human body.
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Affiliation(s)
- Hubertus Himmerich
- a Department of Psychological Medicine , King's College London , London , UK
| | - Janet Treasure
- a Department of Psychological Medicine , King's College London , London , UK
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42
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Zugai JS, Stein-Parbury J, Roche M. The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: A mixed-methods study. J Clin Nurs 2017; 27:416-426. [DOI: 10.1111/jocn.13944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Joel S. Zugai
- Australian Catholic University; Banyo QLD Australia
- University of Technology Sydney; Ultimo NSW Australia
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Abstract
AbstractAnorexia nervosa (AN) is a notoriously costly and challenging psychiatric illness to treat. Despite an accumulating evidence base, psychological treatment fails to achieve symptom abstinence in many patients with eating disorders, a shortcoming that is likely to be further pronounced in AN. The case study reported here describes how a mutually agreed break in a course of psychotherapy following an initial lack of progress might have influenced outcome for a client with a severe eating disorder. The patient received 26 sessions of CBT and results, consistent with those of larger studies, showed significant improvement on primary symptom measures. These results are discussed in the context of relevant psychological theories and an exploration of the client's motivation. Consideration is also given to other factors that may have influenced outcome.
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Liu W, Li D, Sun F, Zhang X, Wang T, Zhan S, Pan Y, Huang P, Jin H, Li Y, Sun B. Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa. Neurosurgery 2017; 83:86-92. [DOI: 10.1093/neuros/nyx366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/09/2017] [Indexed: 02/05/2023] Open
Abstract
Abstract
BACKGROUND
Anorexia nervosa (AN) is one of the most challenging psychiatric disorders to treat. The poor clinical outcomes warrant novel treatments for AN, especially in severe and persistent cases.
OBJECTIVE
To explore the feasibility of magnetic resonance imaging-guided bilateral anterior capsulotomy in the treatment of refractory AN.
METHODS
Seventy-four patients diagnosed with refractory AN who underwent capsulotomy completed this 3-yr follow-up study. Outcomes included body mass index (BMI) and results from a series of psychiatric scales (for obsessive, depressive, and anxious symptoms) that were implemented at baseline (presurgery), and 1 mo, 1 yr, and 3 yr after surgery.
RESULTS
Compared to presurgical levels, BMI increased significantly at 1-yr and 3-yr follow-ups. Compared to presurgery scores, psychiatric scale scores were significantly improved at 1-mo postsurgery, and continued to remain low at the 1-yr and 3-yr follow-ups. In addition, Mini-Mental State Examination (MMSE) scores were in the normal range during the long-term follow-up. The most common short-term side effects included urinary incontinence (n = 7), sleep disorders (n = 8), and fatigue (n = 6). Long-term complications included disinhibition (n = 6), memory loss (n = 3), and lethargy (n = 4). No patient in this study experienced death or disability.
CONCLUSION
Capsulotomy enabled patients with refractory AN to normalize their weight, especially those in life-threatening conditions. While it appears to be an acceptable life-saving treatment, it is indicated only when fulfilling strict criteria given its complications and irreversibility.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Fafa Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiao Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School, of Medicine, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Shanghai YangPu District Mental Health Center, Shanghai, China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai, Jiao Tong University School of Medicine, Shanghai, China
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Tomba E, Tecuta L, Schumann R, Ballardini D. Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders. Compr Psychiatry 2017; 74:61-69. [PMID: 28107643 DOI: 10.1016/j.comppsych.2017.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/06/2016] [Accepted: 01/04/2017] [Indexed: 11/20/2022] Open
Abstract
Psychological well-being changes following cognitive-behavioral therapy-based treatment were investigated in outpatients with eating disorders (ED). While it is known that CBT reduces symptomatology in EDs, less is known about how changes in positive functioning may ensue. One-hundred and eighty five ED outpatients were analyzed for pre-treatment and post-treatment changes in psychological well-being (PWB) by last observation carried forward - Wilcoxon signed rank tests. Significant gains in all PWB dimensions were found, with moderate effect size correlations in environmental mastery (r=-.418), personal growth (r=-.351) and self-acceptance (r=-.341). A subsample of patients in remission (n=51) was selected and compared to healthy controls in PWB post-treatment scores through Mann-Whitney U tests. Remitted patients showed significantly lower psychological well-being in two dimensions compared to controls: PWB-positive relations (r=-.360) and PWB-self-acceptance (r=-.288). However, more than 50% of ED outpatients in remission had PWB scores that fell below the 50th percentile of healthy controls in all psychological well-being dimensions, despite significant treatment response. Several mechanisms of psychological well-being change following CBT-based treatment are discussed. The assessment of treatment outcome in EDs may benefit from considering changes in positive functioning such as psychological well-being, in addition to the standard measurement of BMI, symptomatology and behavioral parameters. CBT-based treatment outcomes may be strengthened by promoting the development of optimal domains particularly in the interpersonal realm, such as building of quality and warm relationships and focusing on enhancing self-acceptance.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
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46
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Abstract
Dissonance-based eating disorder prevention leads to decreases in risk factors for these disorders. Although controlled trials have demonstrated that targeted, manualized programs reduce eating disorder risk, concerns regarding implementation and dissemination remain. A primary concern is the difficulty in adapting programs for a high school setting for populations at highest risk: adolescents. This paper describes the REbeL Peer Education model and assesses the initial pilot trials of the intervention. The program is novel in that it utilizes a voluntary, self-selection model that is sustainable in a high school setting, and focuses on empowerment and effective cognitive dissonance based prevention activities. High school peer-educators self-selected into the semi-manualized dissonance based intervention. Group activities were peer led, designed to critique the thin ideal, and designed to empower macro (school and larger community wide) changes in The pilot trial (N=47) assess the effectiveness and feasibility of the intervention. Results of the initial pilot study revealed preliminary support for the feasibility of the program, increases in feelings of empowerment, and decreases in eating disorder cognitions and behaviors with moderate to large effect sizes. Feedback from participants indicated that the intervention was enjoyable, educational, and empowering. This study is the first to adapt dissonance-based prevention models to a semi-manualized, peer-led, prevention program integrated into high school settings.
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47
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Guarda AS, Schreyer CC, Fischer LK, Hansen JL, Coughlin JW, Kaminsky MJ, Attia E, Redgrave GW. Intensive treatment for adults with anorexia nervosa: The cost of weight restoration. Int J Eat Disord 2017; 50:302-306. [PMID: 28130794 DOI: 10.1002/eat.22668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Weight restoration in anorexia nervosa (AN) is associated with lower relapse risk; however rate of weight gain and percent of patients achieving weight restoration (BMI ≥ 19 at discharge) vary among treatment programs. We compared both cost/pound of weight gained and cost of weight restoration in a hospital-based inpatient (IP)-partial hospitalization (PH) eating disorders program to estimates of these costs for residential treatment. METHOD All adult first admissions to the IP-PH program with AN (N = 314) from 2003 to 2015 were included. Cost of care was based on hospital charges, rates of weight gain, and weight restoration data. Results were compared with residential treatment costs extracted from a national insurance claims database and published weight gain data. RESULTS Average charge/day in the IP-PH program was $2295 for IP and $1567 for PH, yielding an average cost/pound gained of $4089 and $7050, respectively, with 70% of patients achieving weight restoration. Based on published mean weight gain data and conservative cost/day estimates, residential treatment is associated with higher cost/pound, and both higher cost and lower likelihood of weight restoration for most patients. DISCUSSION The key metrics used in this study are recommended for comparing the cost-effectiveness of intensive treatment programs for patients with AN.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York.,Department of Psychiatry, Weill Cornell Medical College, New York
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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48
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Makhzoumi SH, Coughlin JW, Schreyer CC, Redgrave GW, Pitts SC, Guarda AS. Weight gain trajectories in hospital-based treatment of anorexia nervosa. Int J Eat Disord 2017; 50:266-274. [PMID: 28186654 DOI: 10.1002/eat.22679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/30/2023]
Abstract
Weight gain is a primary treatment goal for anorexia nervosa (AN); however little is known about heterogeneity in weight gain pattern during treatment. Preliminary evidence suggests weight gain trajectory is associated with treatment outcome. This study grouped patients using mixture modeling into weight gain trajectories, and compared predictors and treatment outcomes between trajectory groups. Women diagnosed with AN or subthreshold AN (N = 211) completed self-report measures at admission and six-months after discharge from an integrated inpatient (IP)-partial hospitalization (PH) behavioral specialty eating disorders program. Gowned weights were measured daily. Three distinct trajectories emerged: negative quadratic (Optimal), negative quadratic with fast weight gain (Fast), and positive linear with slower weight gain (Slow). The majority of patients were assigned to the Optimal group. Trajectory groups differed on admission, discharge, and follow-up variables. The Fast group emerged as most distinct. Women in this group were more than twice as likely to binge and or vomit regularly compared with the other two groups and were most likely to achieve weight restoration by discharge and to have more positive weight outcomes at short-term follow-up. There were no group differences in eating disorder behavioral frequencies at follow-up when adjusting for behavioral severity at admission. Weight gain trajectory may serve as a personalized in-treatment marker of outcome and could inform research on moderators and mediators of treatment response. Randomized controlled treatment studies, utilizing weight gain trajectories to determine group membership, may help identify subgroups of patients with differential responses to treatment interventions.
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Affiliation(s)
- Saniha H Makhzoumi
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven C Pitts
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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49
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Cunningham ML, Griffiths S, Mitchison D, Mond JM, Castle D, Murray SB. Muscle Dysmorphia: An Overview of Clinical Features and Treatment Options. J Cogn Psychother 2017; 31:255-271. [DOI: 10.1891/0889-8391.31.4.255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increasing public and empirical focus on male body image indicates that muscularity is a preeminent concern among boys and men. For some, these concerns develop into a complex and disabling psychiatric disorder termedmuscle dysmorphia(MD), the hallmark of which is an intense preoccupation regarding one’s (subjectively) insufficient muscularity. Treatment of MD is critical; however, evidence to inform treatment approaches is sorely lacking. The purpose of this article is twofold. First, we provide an overview of the clinical features of MD, drawing particular attention to the preoccupation, functional impairment and psychiatric comorbidity associated with the disorder. Second, we discuss and recommend potential treatment directions for MD, including techniques that have demonstrated efficacy in the treatment of related disorders, namely, body dysmorphic disorder and eating disorders (and anorexia nervosa in particular). Psychotherapeutic techniques, including cognitive restructuring of deleterious perfectionistic and egosyntonic beliefs, and dialectical behavioral techniques to improve the repertoire of emotion regulation skills available to afflicted individuals, are discussed, in addition to psychopharmacological approaches.
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50
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Boisseau CL. Identification and management of eating disorders in gynecology: menstrual health as an underutilized screening tool. Am J Obstet Gynecol 2016; 215:572-578. [PMID: 27422054 DOI: 10.1016/j.ajog.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/18/2016] [Accepted: 07/05/2016] [Indexed: 02/01/2023]
Abstract
Eating disorders are life-threatening conditions that disproportionately affect females, often during child-bearing years. Although the endocrinological and reproductive sequelae of these conditions often fall within the treatment purview of obstetrician-gynecologists, the assessment of eating pathology is challenging and often not part of routine clinical care. This commentary focuses on one of the common presenting symptoms of eating disorders in women, menstrual dysfunction, and discusses considerations for its clinical management in gynecology. Assessment of menstrual status provides a natural starting point for provider-patient discussion of disordered eating and weight behavior. Routine screening for eating disorders is critical and must be universal given the serious long-term consequences of these disorders.
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