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Gradl-Dietsch G, Peters T, Meule A, Hebebrand J, Voderholzer U. Body Mass Index Distribution in Female Child, Adolescent and Adult Inpatients with Anorexia Nervosa-A Retrospective Chart Review. Nutrients 2024; 16:1732. [PMID: 38892665 PMCID: PMC11175141 DOI: 10.3390/nu16111732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years. METHODS The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting. RESULTS We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10-4). In adults, BMI was not correlated with age (r = -0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; p < 0.001 and r = -0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting. CONCLUSIONS In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.
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Affiliation(s)
- Gertraud Gradl-Dietsch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Adrian Meule
- Department of Psychology, University of Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany;
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburg Str. 21, 45147 Essen, Germany; (T.P.); (J.H.)
- Center for Translational Neuro and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, 80539 Munich, Germany;
- Schoen Clinic Roseneck, 83209 Chiemsee, Germany
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Smith S, Sutandar K, Woodside B. Premature termination of inpatient eating disorder treatment: Does timing matter? J Eat Disord 2023; 11:210. [PMID: 38012804 PMCID: PMC10680217 DOI: 10.1186/s40337-023-00934-5] [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: 02/21/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.
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Affiliation(s)
- Sarah Smith
- Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, 25 Sheppard Ave West, Suite 300, Toronto, ON, M2N 6S6, Canada
| | - Blake Woodside
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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Rienecke RD, Dimitropoulos G, Duffy A, Le Grange D, Manwaring J, Nieder S, Sauerwein J, Singh M, Watters A, Westmoreland P, Mehler PS. Involuntary treatment: A qualitative study from the perspectives of individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:850-862. [PMID: 37424216 DOI: 10.1002/erv.3010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Involuntary treatment for anorexia nervosa (AN) is sometimes necessary and lifesaving but can be experienced negatively by some individuals. The purpose of this qualitative study was to better understand participants' perceptions about their experience with involuntary treatment for AN. METHOD Thirty adult participants, who had been treated involuntarily for AN in the past, completed self-report measures and qualitative interviews. Interview transcripts were coded using thematic analysis. RESULTS Three themes were identified: (1) mixed perceptions about involuntary treatment, (2) the impact of involuntary treatment on external factors, including relationships, education, and employment, and (3) lessons learned from the experience. Participants who endorsed a positive shift in perspective regarding the need for involuntary treatment also reported favorable changes in their eating disorder recovery, whereas individuals whose perspective about their involuntary treatment remained negative, showed no changes in their recovery post-treatment. CONCLUSIONS Involuntary treatment for AN was recognized, in retrospect, as being beneficial by individuals with AN who were doing well, but individuals who continued to struggle with their eating disorder reported negative consequences.
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Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Gina Dimitropoulos
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | | | - Jessica Sauerwein
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Manya Singh
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Ashlie Watters
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Patricia Westmoreland
- Department of Psychiatry, University of Colorado, Denver, Colorado, USA
- Aurora Medical Center, Aurora, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Centers, Denver, Colorado, USA
- ACUTE, Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
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Amianto F, Arletti L, Vesco S, Davico C, Vitiello B. Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors. BMC Psychiatry 2023; 23:366. [PMID: 37231436 PMCID: PMC10210459 DOI: 10.1186/s12888-023-04855-0] [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: 10/21/2022] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators. METHODS Seventy-three female participants affected with AN were assessed at intake (T0) and at 6 (T1) and 12 (T2) months of an outpatient multimodal treatment program. Nineteen participants were assessed 15 years after discharge (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures, using the t-test or Wilcoxon test as post-hoc. T0 features among dropout, stable and healed participants were compared. Healed and unhealed groups at long-term follow-up were compared using Mann-Whitney U test. Treatment changes were correlated to each other and with intake features using multivariate regression. RESULTS The rate of complete remission was 64.4% at T2, and 73.7% at T3. 22% of participants maintained a full diagnosis at T2, and only 15.8% at T3. BMI significantly increased at each time-point. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, impulsivity, parent-rated, and adolescent-rated general psychopathology significantly decreased after treatment. Lower reward dependence and lower cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing symptoms, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with BMI, personality and psychopathology at intake. CONCLUSION A 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate AN in adolescence. Treatment was associated not only with increased BMI but also with positive personality development, and changes in both eating and general psychopathology. Lower relational abilities may be an obstacle to healing. Approaches to treatment resistance should be personalized according to these finding.
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Affiliation(s)
- Federico Amianto
- Department of Neuroscience, Section of Child and Adolescent Neuropsychiatry, University of Turin, Via Cherasco, 15 - 10126, Turin, Italy.
| | - Luca Arletti
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Serena Vesco
- Department of Pathology and Care of the Children, Regina Margherita Hospital, Turin, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
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Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [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: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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Treatment response in children and adolescents with anorexia nervosa: a naturalistic, case-control study. Eat Weight Disord 2022; 27:2879-2887. [PMID: 35704179 PMCID: PMC9556349 DOI: 10.1007/s40519-022-01425-3] [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: 01/23/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Although a few recent articles describe adults with treatment-resistant anorexia nervosa (TR-AN), no study addresses the specific features of subjects not responding to treatment in the developmental age. This study reports on the clinical and psychopathological variables that distinguish children and adolescents who did not respond to treatment (here "TR-AN") from good-outcome controls, in a multidisciplinary hospital treatment setting. METHODS Naturalistic, case-control study conducted on individuals showing lack of response to treatment and good-outcome controls. TR-AN was defined as two or more incomplete admissions and no complete admissions, consistently with studies in adults. Good-outcome was defined as complete first admission, availability for follow-up visit after 6 months, and maintaining at follow-up a %BMI > 70% in the absence of binging or purging in the preceding 3 months. Psychopathological (Eating Disorders Inventory-3 EDI-3; Beck Depression Inventory-II), clinical, and treatment variables at admission were compared. Significant differences in the univariate analyses were included in an exploratory binary logistic regression. RESULTS Seventy-six patients (30 TR-AN, 46 good-outcome AN controls) were enrolled (mean age 14.9 ± 1.9 years, F = 94.7%). TR-AN individuals had a higher age at admission and higher EDI-3 Eating Disorder Risk (EDRC) scores, were treated less frequently with a nasogastric tube (NGT), and achieved a lower BMI improvement at discharge than good-outcome controls. A predictive model for TR-AN status was found (X2 = 19.116; Nagelkerke-R2 = 0.478, p < 0.001), and age at admission (OR = 0.460, p = 0.019), EDI-3 EDRC (OR = 0.938, p = 0.043), and NGT (OR = 8.003, p = 0.019) were associated with a TR-AN status. CONCLUSIONS This is the first report on the psychopathological and clinical characteristics of children and adolescents not responding to treatment. These patients showed higher age and eating disorder scores, and were less frequently fed with NGT than controls. Despite the multiple incomplete admissions of our subjects, the short included follow-up limits the possibility for direct comparisons with adult samples of treatment-resistant patients. Thus, the specific features of children and adolescents with TR-AN should be assessed in longitudinal studies. LEVEL OF EVIDENCE III, Observational, case-control study.
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Fernández D, Vigo D, Sampson NA, Hwang I, Aguilar-Gaxiola S, Al-Hamzawi AO, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, de Jonge P, Florescu S, Gureje O, Hinkov H, Hu C, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Ojagbemi A, O’Neill S, Piazza M, Posada-Villa J, Rapsey C, Williams DR, Xavier M, Ziv Y, Kessler RC, Haro JM. Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative. Psychol Med 2021; 51:2104-2116. [PMID: 32343221 PMCID: PMC8265313 DOI: 10.1017/s0033291720000884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. METHODS Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. RESULTS Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. CONCLUSIONS Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
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Affiliation(s)
- Daniel Fernández
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia, Barcelona, Spain
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali O. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | | | - Peter de Jonge
- Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Hristo Hinkov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Andrzej Kiejna
- Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Siobhan O’Neill
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Miguel Xavier
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
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Muzi L, Tieghi L, Rugo MA, Lingiardi V. Personality as a predictor of symptomatic change in a residential treatment setting for anorexia nervosa and bulimia nervosa. Eat Weight Disord 2021; 26:1195-1209. [PMID: 33048329 PMCID: PMC8062347 DOI: 10.1007/s40519-020-01023-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Although personality has been widely researched in patients with anorexia nervosa (AN) and bulimia nervosa (BN), the nature of this relationship has not yet been clearly articulated. The pathoplasty model theorizes that personality might shape symptomatic presentation and thus affect therapeutic outcomes, but more research is needed. The present study aimed at investigating the predictive value of a broad spectrum of personality traits in determining AN and BN treatment outcomes, considering both the statistical and clinical significance of the therapeutic change. METHODS Eighty-four female patients with AN and BN treated in a residential program were evaluated at treatment onset using the Shedler-Westen Assessment Procedure-200-a clinician-rated measure of personality disorders and healthy personality functioning. At both intake and discharge, patients completed the Eating Disorder Inventory-3 to assess eating symptoms and the Outcome Questionnaire-45.2 to evaluate overall impairment. RESULTS Considering overall ED symptomatic change, multiple regression analyses showed that, even when controlling for baseline symptoms and DSM-5 categories, schizoid (B = 0.41, p ≤ 0.01), avoidant (B = 0.31, p ≤ 0.05), and paranoid (B = 0.25, p ≤ 0.05) personality features predicted worse therapeutic outcomes. Similar results were found when applying the clinical significance approach, with the emotionally dysregulated factor as an additional negative predictor of significant/reliable change (B = - 0.09; p < 0.01). Healthy personality functioning predicted better therapeutic outcomes (B = - 0.34, p ≤ 0.001). CONCLUSIONS Pathoplastic models and personality-based research in this clinical population have the potential to inform effective treatment strategies by targeting relevant individual factors. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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Affiliation(s)
- Laura Muzi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy.
| | - Laura Tieghi
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185, Rome, Italy
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Dardennes R, Tolle V, Lavoisy G, Grouselle D, Alanbar N, Duriez P, Gorwood P, Ramoz N, Epelbaum J. Lower leptin level at discharge in acute anorexia nervosa is associated with early weight-loss. EUROPEAN EATING DISORDERS REVIEW 2021; 29:634-644. [PMID: 33880836 DOI: 10.1002/erv.2830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2-month follow-up weight loss as a proxy to poor outcome. METHOD Fasting plasma levels of leptin, acyl-ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2-month postdischarge was considered a poor outcome. RESULTS Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl-ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome. CONCLUSION Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.
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Affiliation(s)
- Roland Dardennes
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Guillaume Lavoisy
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Dominique Grouselle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Nebal Alanbar
- Faculté de Médecine, Université de Paris Descartes, Paris, France
| | - Philibert Duriez
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Philip Gorwood
- Faculté de Médecine, Université de Paris Descartes, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.,Clinique des Maladies Mentales et de l'encéphale, Hospital Sainte-Anne, Paris, France
| | - Nicolas Ramoz
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
| | - Jacques Epelbaum
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France
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10
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Individualisierte Therapieplanung mithilfe des Gewichtsmappings bei Anorexia nervosa. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Anorexia nervosa ist eine seltene, schwerwiegende Erkrankung, deren Therapie bislang oft nur mäßig wirksam ist. Stagnierende Verläufe oder ein erhebliches Auf und Ab in der Gewichtsentwicklung zwischen stationären Behandlungen und dem häuslichen Transfer sind verbreitet und können stationäre Aufnahmen bzw. Wiederaufnahmen notwendig machen. Im Folgenden werden daher Techniken des Gewichtsmappings vorgestellt, die eine individualisierte Therapieplanung ermöglichen. Hierzu zählt zum einen die retrospektive Analyse des Lifecharts, in der die Gewichtsentwicklung über die Lebenspanne aufgezeigt wird und die damit Schweregrad der Essstörung, Krankheitsdauer und -verlauf sowie transdiagnostisch relevante Prozesse veranschaulichen kann. Zum anderen gehört dazu die prospektive Technik des Gewichtsmappings, die in einem standardisierten Vorgehen die individuell relevanten Gewichtsmarker erfasst und visualisiert. Diese diagnostischen Informationen können eine personalisierte Therapieplanung unterstützen, die sowohl den Zeitverlauf als auch den Schwierigkeitsgrad des Bewältigungsprozesses antizipiert. Mithilfe der Techniken des Gewichtsmanagements kann die Expositionsbehandlung zielgerichtet therapeutisch angeleitet und begleitet werden. Dabei werden die Arbeit mit Intervallmodulen und ihre Rolle für eine bewältigungsorientierte Expositionsbehandlung diskutiert.
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11
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Kan C, Hawkings YR, Cribben H, Treasure J. Length of stay for anorexia nervosa: Systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2021; 29:371-392. [PMID: 33548148 DOI: 10.1002/erv.2820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evidence regarding global trends in length of stay for patients with anorexia nervosa is limited. The aim of this study is to conduct a meta-analysis examining the length of stay for anorexia nervosa patients globally, and to investigate moderators of the variance. METHOD Medline, EMBASE and PsycINFO were searched for studies published up to January 2019. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. A meta-analysis was performed to calculate a pooled mean length of stay using the random-effects model. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity between studies. RESULTS Of 305 abstracts reviewed, 71 studies met the inclusion criteria, generating 111 datasets. The pooled mean length of stay (95% confidence interval) was 76.3 days (73.3, 79.4) using the random-effects model, with marked variation across countries and time. Heterogeneity between studies was explained by age and admission body mass index. CONCLUSIONS This meta-analysis found that although clinical features do contribute to length of admissions for anorexia nervosa, there are also global and temporal variations. Future research should provide an in-depth analysis of why and how this variation exists and what the impact is on the well-being of people with anorexia nervosa.
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Affiliation(s)
- Carol Kan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Hannah Cribben
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Chatelet S, Wang J, Gjoertz M, Lier F, Monney Chaubert C, Ambresin AE. Factors associated with weight gain in anorexia nervosa inpatients. Eat Weight Disord 2020; 25:939-950. [PMID: 31119585 DOI: 10.1007/s40519-019-00709-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Nutrition restoration in inpatients with anorexia nervosa (AN) is a core element in treatment, enabling recovery of cognitive functions essential for psychological care. This study aims to identify factors associated with inpatient weight gain. METHODS Medical records from 107 inpatients aged 13-55 years with AN, hospitalized for more than 7 days at a specialized unit, were examined in a retrospective study. Weight evolution graphs were created for each patient and graded independently as optimal, moderate, and inadequate weight gain after 2 weeks and increasing, flat or decreasing weight in the first 2 weeks by expert clinicians. Driven by explicit hypotheses, bivariable analyses were carried out to detect relevant factors associated with weight gain during and after the first 2 weeks of admission. RESULTS Initial weight gain in the first 2 weeks of hospitalization and the introduction of a protocol harmonizing treatment procedures around rapid refeeding were strong factors associated with optimal weight gain after 2 weeks of hospitalization, whereas prior hospitalization in a psychiatric unit, diagnosis with binge-eating/purging subtype and age over 18 years were significantly associated with inadequate weight gain (p < 0.001-0.05). CONCLUSION To promote weight gain during hospitalization, clinicians should consider the following therapeutic measures: rapid refeeding strategies, renutrition protocols, and controlling purging behaviors. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Solène Chatelet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jen Wang
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland
| | - Mathea Gjoertz
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Françoise Lier
- Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland.,Vaudois Centre for Anorexia and Bulimia (abC), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carole Monney Chaubert
- Etablissements Hospitaliers du Nord-Vaudois (eHnv): St. Loup Hospital, Pompaples, Switzerland
| | - Anne-Emmanuelle Ambresin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. .,Interdisciplinary Division for Adolescent Health (DISA), Lausanne University Hospital (CHUV), Hôpital Nestlé 04-312, Avenue de la Sallaz 2, 1011, Lausanne, Switzerland.
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13
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Smith S, Woodside DB. Characterizing Treatment-Resistant Anorexia Nervosa. Front Psychiatry 2020; 11:542206. [PMID: 33488410 PMCID: PMC7819894 DOI: 10.3389/fpsyt.2020.542206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The issue of treatment resistance in eating disorder care is controversial. Prior research has identified multiple failed treatment attempts as a common criterion for severe and enduring anorexia nervosa, but little is known about patients who have multiple failed treatment attempts. This study was designed to compare the clinical and demographic characteristics of eating disorder patients with multiple, incomplete inpatient admissions to those with good outcomes. Understanding if these patient populations differ at initial admissions has implications for the prediction and characterization of inpatient eating disorder treatment resistance. Methods: This study analyzed existing data from a specialist inpatient eating disorder program at a large Canadian teaching hospital collected between 2000 and 2016. Treatment resistance was defined as two or more incomplete admissions and no complete admissions in the study period. Data were available on 37 patients who met this criteria, and 38 patients who had completed their first admission and remained well (defined as a BMI > 18.5 with no binging or purging behavior) 1 year after discharge. Variables of interest included age, weight, diagnoses, duration of illness, eating disorder psychopathology, eating disorder behavioral frequencies and depressive symptoms at the time of index inpatient admissions. Statistical analyses consisted of Mann-Whitney U tests, Chi-square tests, and a logistic regression. Results: In our main bivariate analyses, patients with multiple incomplete admissions were characterized by more severe eating disorder psychopathology and depressive symptoms at admission as well as an increased prevalence of the binge purge subtype of anorexia nervosa. In our exploratory multivariate analyses controlling for diagnostic subtype and depressive symptoms, severity of eating disorder psychopathology did not remain significant. No statistically significant difference in body mass index (BMI) or frequencies of eating disorder behaviors were found. A trend toward a longer duration of illness did not meet statistical significance. Conclusions: This study found that patients considered resistant to inpatient eating disorder treatment differ from those with good outcomes at initial admission. These results suggest that while treatment-resistant anorexia nervosa may be related to severe and enduring anorexia nervosa, it may also be a different concept that warrants additional research.
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Affiliation(s)
- Sarah Smith
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, Toronto, ON, Canada
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14
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Mandelli L, Arminio A, Atti AR, De Ronchi D. Suicide attempts in eating disorder subtypes: a meta-analysis of the literature employing DSM-IV, DSM-5, or ICD-10 diagnostic criteria. Psychol Med 2019; 49:1237-1249. [PMID: 30488811 DOI: 10.1017/s0033291718003549] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Quantification of suicidal risk in specific populations is important for the adoption of targeted prevention and harm reduction measures. Though there remains little systematic evidence, risk of suicide attempts for bulimia nervosa (BN) and binge-purging anorexia nervosa (AN-bp) appears higher than restrictive AN (AN-r); risk in binge eating disorder (BED) is still unclear. The aim of this meta-analysis was to compare proportions of suicide attempts in eating disorder (ED) subgroups. METHODS A literature search using combinations of key-words for ED and suicide attempts was performed. Studies reporting proportions of suicide attempters in at least two ED groups, diagnosed according to DSM-IV or -5 and ICD-10 diagnostic criteria were considered. ED subgroups were analyzed in pairs using a binary random effect model for proportions. Publication bias, meta-regression, and sensitivity analyses were performed. RESULTS In BN, attempted suicide was more frequent (21%) than in AN (12.5%), but the difference was statistically significant only when BN was compared with AN-r (9-10%). In BED, the proportion of suicide attempts was as high as in AN (10-12%). CONCLUSIONS Though limited by heterogeneity across the studies in terms of methodology and aims, inability to control for relevant confounding variables, exclusion of ED not otherwise specified, this study supports suicide attempts as a major issue in EDs, especially in binge-purging subtypes, i.e. BN and AN-bp. Similar suicidal proportions were observed in AN and BED. The reasons for a greater proportion of attempted suicide in binge/purging subtypes need to be explored in future studies.
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Affiliation(s)
- Laura Mandelli
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Angelo Arminio
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Anna-Rita Atti
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences,University of Bologna,Bologna,Italy
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15
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Kästner D, Löwe B, Gumz A. The role of self-esteem in the treatment of patients with anorexia nervosa - A systematic review and meta-analysis. Int J Eat Disord 2019; 52:101-116. [PMID: 30488479 DOI: 10.1002/eat.22975] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment. METHOD The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses. RESULTS A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment. DISCUSSION The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.
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Affiliation(s)
- Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
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16
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Jennings KM, Gregas M, Wolfe B. Trajectories of Change in Body Weight During Inpatient Treatment for Anorexia Nervosa. J Am Psychiatr Nurses Assoc 2018; 24:306-313. [PMID: 28817991 PMCID: PMC5794613 DOI: 10.1177/1078390317726142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Identifying distinct trajectories of change in body weight during inpatient treatment for anorexia nervosa (AN) may provide knowledge about the process of weight restoration and may help detect optimal body weight response patterns among individuals who are at risk for not achieving weight restoration or leaving treatment prematurely. OBJECTIVE This study explored the extent to which distinct trajectories of change in body weight existed among individuals during inpatient treatment for AN. DESIGN Group-based trajectory modeling was used to identify distinct trajectories of change in body weight among 500 individuals receiving inpatient treatment for AN. RESULTS Four distinct trajectories were identified: weight gain ( n = 197), treatment resistant ( n = 177), weight plateau ( n = 82), and weight fluctuate ( n = 44). CONCLUSION Clinically, it is important to consider the heterogeneity of changes in body weight during inpatient treatment to help guide interventions and outcomes.
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Affiliation(s)
- Karen M Jennings
- 1 Karen M. Jennings, PhD, RN, PMHNP-BC, University of Chicago, Chicago, IL, USA
| | - Matthew Gregas
- 2 Matthew Gregas, PhD, Boston College, Chestnut Hill, MA, USA
| | - Barbara Wolfe
- 3 Barbara Wolfe, PhD, RN, FAAN, University of Rhode Island, Kingston, RI, USA
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17
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Schreyer CC, Redgrave GW, Hansen JL, Guarda AS. Self-selection bias in eating disorders outcomes research: Does treatment response of underweight research participants and non-participants differ? Int J Eat Disord 2017; 50:602-605. [PMID: 28225563 DOI: 10.1002/eat.22650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 11/11/2022]
Abstract
Observational treatment studies provide a valuable alternative to RCTs but are often criticized due to potential self-selection biases. Studies comparing those who do and do not participate in research on eating disorder treatment are scarce, but necessary to evaluate the impact of self-selection bias on outcomes. All consecutive underweight adult first admissions (N = 392) to an integrated inpatient (IP)-partial hospital (PH) behavioral specialty program were invited to participate in a longitudinal study of eating disorder treatment. Demographic and hospital course data were collected on participants (n = 234) and non-participants (n = 158). Participants and non-participants had similar BMI at admission, lengths of stay, and weight gain rates. Participants were less likely than non-participants to end treatment prematurely from IP and were discharged at a higher BMI; the effect size was small. Few differences in hospital course were observed between participants and non-participants. Although participants were more likely to transition to PH and were discharged at a higher BMI, completion of step-down to PH within this integrated IP-PH program rather than research participation status at admission was a better indicator of discharge BMI, which remains the strongest predictor of long-term weight-maintenance in eating disorders.
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18
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Bonjour JP. The dietary protein, IGF-I, skeletal health axis. Horm Mol Biol Clin Investig 2017; 28:39-53. [PMID: 26985688 DOI: 10.1515/hmbci-2016-0003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/12/2016] [Indexed: 12/29/2022]
Abstract
Dietary protein represents an important nutrient for bone health and thereby for the prevention of osteoporosis. Besides its role as a brick provider for building the organic matrix of skeletal tissues, dietary protein stimulates the production of the anabolic bone trophic factor IGF-I (insulin-like growth factor I). The liver is the main source of circulating IGF-I. During growth, protein undernutrition results in reduced bone mass and strength. Genetic defect impairing the production of IGF-I markedly reduces bone development in both length and width. The serum level of IGF-I markedly increases and then decreases during pubertal maturation in parallel with the change in bone growth and standing height velocity. The impact of physical activity on bone structure and strength is enhanced by increased dietary protein consumption. This synergism between these two important environmental factors can be observed in prepubertal boys, thus modifying the genetically determined bone growth trajectory. In anorexia nervosa, IGF-I is low as well as bone mineral mass. In selective protein undernutrition, there is a resistance to the exogenous bone anabolic effect of IGF-I. A series of animal experiments and human clinical trials underscore the positive effect of increased dietary intake of protein on calcium-phosphate economy and bone balance. On the contrary, the dietary protein-induced acidosis hypothesis of osteoporosis is not supported by several experimental and clinical studies. There is a direct effect of amino acids on the local production of IGF-I by osteoblastic cells. IGF-I is likely the main mediator of the positive effect of parathyroid hormone (PTH) on bone formation, thus explaining the reduction in fragility fractures as observed in PTH-treated postmenopausal women. In elderly women and men, relatively high protein intake protects against spinal and femoral bone loss. In hip fracture patients, isocaloric correction of the relatively low protein intake results in: increased IGF-I serum level, significant attenuation of postsurgical bone loss, improved muscle strength, better recovery, and shortened hospital stay. Thus, dietary protein contributes to bone health from early childhood to old age. An adequate intake of protein should be recommended in the prevention and treatment of osteoporosis.
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19
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Roux H, Ali A, Lambert S, Radon L, Huas C, Curt F, Berthoz S, Godart N. Predictive factors of dropout from inpatient treatment for anorexia nervosa. BMC Psychiatry 2016; 16:339. [PMID: 27716113 PMCID: PMC5045614 DOI: 10.1186/s12888-016-1010-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.
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Affiliation(s)
- H. Roux
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - A. Ali
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - S. Lambert
- Service d’Addictologie, CHU Nantes, Paris, France
| | - L. Radon
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - C. Huas
- Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - F. Curt
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - S. Berthoz
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - Nathalie Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France. .,Faculté de Médecine, Université Paris Descartes, Paris, France. .,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France. .,Université Paris Descartes, Paris, France. .,Université Paris Sud, Villejuif, France. .,UVSQ, Villejuif, France. .,Université Paris-Saclay, Villejuif, France.
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Bridges AN, Wormley KA, Leavitt IW, McCord DM. Personality differences in treatment-seeking and non-treatment-seeking individuals with self-reported anorexia. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2015-0116/ijamh-2015-0116.xml. [PMID: 27060734 DOI: 10.1515/ijamh-2015-0116] [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: 12/01/2015] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Research on anorexia has tended to focus on individuals who are seeking treatment, leading to treatment models that are based on individuals already receiving help. Therefore, the purpose of this study was to explore personality differences between individuals seeking treatment and those not seeking treatment for anorexia. Participants were 148 women recruited from three online sources. They completed a personality measure derived from the five-factor model and the Eating Attitudes Test-26. Results indicated that individuals with anorexia who were not seeking treatment scored lower on Agreeableness and Conscientiousness than both individuals seeking treatment and a control group. Also, individuals with anorexia in general tended to score lower on Extraversion and higher on Neuroticism than individuals in a control group. These results suggest that being open about treatment options, increasing successes, motivation, and organization, and highlighting the seriousness of anorexia could be beneficial in getting individuals with anorexia to seek and continue in treatment.
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Martinez MA, Craighead LW. Toward Person(ality)-Centered Treatment: How Consideration of Personality and Individual Differences in Anorexia Nervosa May Improve Treatment Outcome. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schlegl S, Quadflieg N, Löwe B, Cuntz U, Voderholzer U. Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes. BMC Psychiatry 2014; 14:258. [PMID: 25193513 PMCID: PMC4172844 DOI: 10.1186/s12888-014-0258-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/29/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. METHODS A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. RESULTS 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. CONCLUSIONS Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ulrich Cuntz
- Schoen Klinik Roseneck, Prien, Germany ,Paracelsus Medical University, Salzburg, Austria
| | - Ulrich Voderholzer
- Schoen Klinik Roseneck, Prien, Germany ,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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Jordan J, McIntosh VVW, Carter FA, Joyce PR, Frampton CMA, Luty SE, McKenzie JM, Bulik CM. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:278-84. [PMID: 24842307 DOI: 10.1002/erv.2296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022]
Abstract
AIM The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN). METHODS Participants were 56 women aged 17-40 years with spectrum AN. The completer group (n = 35) included those completing at least 15/20 planned sessions with the remainder of the sample comprising the PTT group (n = 21). Variables examined included demographic factors, psychosocial functioning, psychiatric history, lifetime comorbidity, temperament and eating disorder characteristics. Logistic regression was used to examine significant variables. A Kaplan-Meier survival curve was used to illustrate time taken to PTT. RESULTS The mean number of sessions in the PTT group was 8.1. Lower self-transcendence scores on the Temperament and Character Inventory were associated with PTT. CONCLUSIONS Recognising and addressing personality factors have the potential to enhance retention in treatment.
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Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
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Abd Elbaky GB, Hay PJ, le Grange D, Lacey H, Crosby RD, Touyz S. Pre-treatment predictors of attrition in a randomised controlled trial of psychological therapy for severe and enduring anorexia nervosa. BMC Psychiatry 2014; 14:69. [PMID: 24606873 PMCID: PMC3995934 DOI: 10.1186/1471-244x-14-69] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/04/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood. In particular, its relationship with adaptive function and motivational stage of change has been little studied. This study aimed to (1) investigate and (2) compare the strength of associations between adaptive function, stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa (SE-AN). METHODS Participants were 63 adult women with SE-AN of at least 7 years duration who were enrolled in a multi-site randomized controlled trial conducted from July 2007 through June 2011. Treatment comprised 30 outpatient visits over 8 months of either Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN) or Specialist Supportive Clinical Management (SSCM) both of which were modified for severe and enduring illness. Assessments were done at baseline, end of treatment, and 6 and 12 month post treatment follow-up. Demographic variables, duration of illness, specific and generic health related quality of life (QoL), eating disorder (ED) and mood disorder symptoms, social adjustment, body mass index (BMI), and motivation for change were assessed with interview and self-report questionnaires. Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge. Binary logistic regression was used to investigate relative strength of associations. RESULTS Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL. There were no significant differences between attrition and which therapy was received, educational level, and global ED psychopathology, stage of change, BMI, social adjustment, duration of illness or level of depression. The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype. CONCLUSION This study supported previous findings of associations between attrition and purging subtype. Furthermore, we found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported. Contrary to expectations we did not find an association with BMI, severity of ED symptoms, low level of motivation to change ED features, or level of education.
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Affiliation(s)
- Ghada B Abd Elbaky
- NSW Institute of Psychiatry Fellow, University of Western Sydney, School of Medicine, Sydney, Australia
| | - Phillipa J Hay
- School of Medicine, Centre for Health Research, University of Western Sydney, Sydney, Australia
- School of Medicine, James Cook University, Townsville, Australia
| | - Daniel le Grange
- Department of Psychiatry and Behavioural Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Hubert Lacey
- Eating Disorders Research Team, St George’s University of London, London, UK
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA
- Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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Comer JS, Barlow DH. The occasional case against broad dissemination and implementation: retaining a role for specialty care in the delivery of psychological treatments. AMERICAN PSYCHOLOGIST 2014; 69:1-18. [PMID: 23915401 PMCID: PMC4260460 DOI: 10.1037/a0033582] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Mental illness imposes a staggering public health burden in the United States. Although the past 40 years have witnessed tremendous advances in the identification of evidence-based practices (EBPs) in psychological treatments, gaps persist between treatment in experimental settings and services available in the community. In response, considerable attention and large financial commitments have focused in recent years on broad dissemination and implementation efforts designed to improve the quality of psychological services delivered by a variety of generalist practitioners across practice settings. Increasingly, under the influence of the Patient Protection and Affordable Care Act, it is envisioned that these generalists will practice in integrated primary care settings. These advances hold enormous potential, and yet, given the tremendous diversity of mental health problems and human suffering, broad dissemination and implementation efforts to generalists alone may not be sufficient to adequately address the burden of mental illness. Some EBPs may prove too complex for universal dissemination, and the time and expense required for quality dissemination and implementation preclude large-scale training in the treatment of low base rate disorders. As dissemination and implementation efforts work to ensure a quality generalist mental health care workforce, herein we highlight the vital need for available specialty care in the delivery of psychological treatments. Given traditional barriers that interfere with the accessibility of specialty care, we propose the transformative potential of a specialty behavioral telehealth care workforce, transacting with the generalist practitioner workforce to collectively ensure the highest quality and timely delivery of needed treatments to affected individuals.
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Marzola E, Nasser JA, Hashim SA, Shih PAB, Kaye WH. Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry 2013; 13:290. [PMID: 24200367 PMCID: PMC3829207 DOI: 10.1186/1471-244x-13-290] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/08/2013] [Indexed: 02/08/2023] Open
Abstract
Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960-2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30-40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70-100 kcal/kg/day can achieve a weight gain of 1-1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.
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Affiliation(s)
- Enrica Marzola
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Jennifer A Nasser
- Department of Nutrition Sciences, Drexel University, 19102 Philadelphia, PA, USA
| | - Sami A Hashim
- Department of Medicine, St. Luke's/Roosevelt Hospital Center, 10025 New York, NY, USA
| | - Pei-an Betty Shih
- UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA
| | - Walter H Kaye
- UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA
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Goddard E, Hibbs R, Raenker S, Salerno L, Arcelus J, Boughton N, Connan F, Goss K, Laszlo B, Morgan J, Moore K, Robertson D, S S, Schreiber-Kounine C, Sharma S, Whitehead L, Schmidt U, Treasure J. A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 2013; 13:287. [PMID: 24200194 PMCID: PMC3871017 DOI: 10.1186/1471-244x-13-287] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/15/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. METHOD Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). RESULTS One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. CONCLUSIONS Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.
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Affiliation(s)
- Elizabeth Goddard
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Laura Salerno
- Department of Psychology, University of Palermo, Palermo, Italy
| | - Jon Arcelus
- Eating Disorders Service, Brandon Unit, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Nicky Boughton
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK
| | - Ken Goss
- Eating Disorders Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - Bert Laszlo
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - John Morgan
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | - Kim Moore
- Kinver Centre, Eating Disorders, South Staffordshire and Shropshire NHS Foundation Trust, Staffordshire, UK
| | - David Robertson
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Saeidi S
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | | | - Sonu Sharma
- Eating Disorders Service, The Priory Hospital Cheadle Royal, Manchester, UK
| | - Linette Whitehead
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
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Hubert T, Pioggiosi P, Huas C, Wallier J, Maria AS, Apfel A, Curt F, Falissard B, Godart N. Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa. Psychiatry Res 2013; 209:632-7. [PMID: 23639255 DOI: 10.1016/j.psychres.2013.03.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n=86) of hospitalizations; in 42.3% (n=30) of the cases, dropout was initiated by the treatment team and in 58.6% (n=41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic.
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Affiliation(s)
- Tamara Hubert
- Department of Psychiatry, Institut Mutualiste Montsouris (IMM), Paris, France; Department of General Practice, Univ Paris 7 Denis Diderot., Paris, France; Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France; Univ. Paris Ouest Nanterre La Defense, Nanterre, France
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Morris J, Simpson AV, Voy SJ. Length of Stay of Inpatients with Eating Disorders. Clin Psychol Psychother 2013; 22:45-53. [DOI: 10.1002/cpp.1865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 11/05/2022]
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Pingani L, Catellani S, Arnone F, De Bernardis E, Vinci V, Ziosi G, Turrini G, Rigatelli M, Ferrari S. Predictors of dropout from in-patient treatment of eating disorders: an Italian experience. Eat Weight Disord 2012; 17:e290-7. [PMID: 23449083 DOI: 10.1007/bf03325140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). MATERIALS AND METHODS The present study consisted of a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in a three-year period (01/01/2006 - 31/12/2009). Sociodemographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQ), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. RESULTS Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents' divorcing, parents' history of substance abuse and difficulties in interpersonal relationships. DISCUSSION Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.
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Affiliation(s)
- L Pingani
- International PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
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Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors. J Nerv Ment Dis 2012; 200:807-13. [PMID: 22922238 DOI: 10.1097/nmd.0b013e318266bbba] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
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Dejong H, Broadbent H, Schmidt U. A systematic review of dropout from treatment in outpatients with anorexia nervosa. Int J Eat Disord 2012; 45:635-47. [PMID: 22684990 DOI: 10.1002/eat.20956] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dropout from treatment has serious implications for patients, clinicians, and researchers. The aim of this study was to examine rates of dropout from outpatient treatment for anorexia nervosa (AN) and critically examine the various definitions of dropout used. METHOD A systematic review was conducted, including pharmacological and psychological interventions. All articles in PubMed, Web of Science, and the Cochrane Library were considered, and screened against a priori inclusion/exclusion criteria. Relationships between treatment outcome and dropout rate were examined across studies. RESULTS Nineteen relevant studies were identified, with dropout rates ranging from 4.8% (family therapy) to 100% (dietary advice). In most cases, dropout was in the range of 20-40%. Definitions of dropout used varied widely. A significant negative correlation was found between rate of dropout and body mass index (BMI) at 1 year, but this did not remain significant when differences in BMI at baseline were taken into account. DISCUSSION High rates of dropout from treatment for AN have serious implications for recovery, research, and the development of new treatments. A suggested reporting structure is proposed, with the aim of increasing the consistency of dropout reporting and facilitating greater understanding of this phenomenon.
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Affiliation(s)
- Hannah Dejong
- Section of Eating Disorders, Institute of Psychiatry, King's College London, London, United Kingdom.
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Gueguen J, Godart N, Chambry J, Brun-Eberentz A, Foulon C, Divac Phd SM, Guelfi JD, Rouillon F, Falissard B, Huas C. Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord 2012; 45:537-45. [PMID: 22271620 DOI: 10.1002/eat.20987] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clinical characteristics of men and women with severe AN and to analyze mortality in men. METHOD One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008. RESULTS Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62-23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization. DISCUSSION Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission.
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Huas C, Godart N, Caille A, Pham-Scottez A, Foulon C, Divac SM, Lavoisy G, Guelfi JD, Falissard B, Rouillon F. Mortality and Its Predictors in Severe Bulimia Nervosa Patients. EUROPEAN EATING DISORDERS REVIEW 2012; 21:15-9. [DOI: 10.1002/erv.2178] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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