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Costa D, Charvin I, Da Fonseca D, Bat-Pitault F. Day hospital program for anorexia nervosa in children and adolescents: Assessment, management and specific focus on early onset anorexia nervosa. L'ENCEPHALE 2023; 49:557-563. [PMID: 36253185 DOI: 10.1016/j.encep.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The French day hospital program specialized in eating disorders (ED) opened in January 2018. Our study presents preliminary data on clinical profiles of patients with anorexia nervosa (AN). We describe more specifically clinical characteristics of patients with early onset AN and according to their therapeutics orientations. Then, we compare the weight gain of patients managed only in day-patient (DP) treatment with those managed initially inpatient (IP) treatment and relays in DP. METHODS Ninety-two patients with AN, aged between 8 and 18 years, were evaluated with several questionnaires (EDI-2, EDE-Q, BSQ, EDS-R, CDI, STAI-Y, VSP-A, EPN-13). RESULTS Patients with early onset AN, n = 23 (25.3%), presented more restrictive behaviors, less marked dietary symptomatology, a lower degree of clinical perfectionism and a less marked feeling of ineffectiveness than adolescent patients with AN. Regarding the choice of hospitalization modality (DP alone or IP-DP), the only difference highlighted was the severity of patient undernutrition. Among the patients who were treated (IP-DP n = 27 vs DP alone n = 25), the weight evolution after one month and at discharge was favorable for both groups. CONCLUSION These preliminary data suggest the effectiveness of DP in the care of AN in children and adolescents.
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Affiliation(s)
- D Costa
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.
| | - I Charvin
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - D Da Fonseca
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France; Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - F Bat-Pitault
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France; Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
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2
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Anderson KE, Han SC, Kavlich SG, Brown S, Ho J, Everhart SA. Adaptation of family-based treatment within an inpatient medical stabilization program for children with eating disorders. Int J Eat Disord 2023; 56:1511-1519. [PMID: 37129459 DOI: 10.1002/eat.23979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family-based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. METHOD The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. RESULTS The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. DISCUSSION Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. PUBLIC SIGNIFICANCE This article describes how a children's hospital has adopted family-based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings.
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Affiliation(s)
| | - Sohyun C Han
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Sarah G Kavlich
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Shonda Brown
- Children's Hospital of Orange County, Mission Viejo, California, USA
| | - Jennifer Ho
- Children's Hospital of Orange County, Mission Viejo, California, USA
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3
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Van Huysse JL, Lock J, Le Grange D, Rienecke RD. Weight gain and parental self-efficacy in a family-based partial hospitalization program. J Eat Disord 2022; 10:116. [PMID: 35941708 PMCID: PMC9361508 DOI: 10.1186/s40337-022-00634-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is an outpatient therapy, though FBT principles have been incorporated in higher levels of care (e.g., partial hospitalization programs, PHPs). It is unknown how participation in a family-based PHP impacts weight restoration and parental self-efficacy. METHODS Weight gain and parental self-efficacy were examined in 98 participants with anorexia nervosa or atypical anorexia nervosa during the first five weeks of participation in a family-based PHP. Maternal self-efficacy was assessed using the Parent versus Anorexia Scale. RESULTS Significant increases in weight, percent expected body weight (EBW), and maternal self-efficacy were observed, with large effect sizes. During the first five weeks of treatment, patients in the PHP gained an average of 4.5 kg, or 8.3% EBW. Maternal self-efficacy improved within two weeks of treatment. CONCLUSIONS Findings suggest that family-based PHPs may facilitate rapid weight restoration without decreasing parental self-efficacy. Randomized trials are needed to directly compare family-based PHPs to outpatient FBT and PHPs with alternate treatment approaches, including longer-term follow-up and cost-effectiveness modeling.
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Affiliation(s)
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA. .,Department of Psychiatry and Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, IL, USA.
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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4
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Family-Empowered Treatment in Higher Levels of Care for Adolescent Eating Disorders: The Role of the Dietitian. J Acad Nutr Diet 2022; 122:1825-1832. [PMID: 35738535 DOI: 10.1016/j.jand.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
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5
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Homan KJ, Crowley SL, Rienecke RD. Predictors of improvement in a family-based partial hospitalization/intensive outpatient program for eating disorders. Eat Disord 2021; 29:644-660. [PMID: 32174240 DOI: 10.1080/10640266.2020.1734410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.
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Affiliation(s)
- Kendra J Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L Crowley
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Huryk KM, Casasnovas AF, Feehan M, Paseka K, Gazzola P, Loeb KL. Lower rates of readmission following integration of family-based treatment in a higher level of care. Eat Disord 2021; 29:677-684. [PMID: 33135596 DOI: 10.1080/10640266.2020.1823173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There has been a growing effort to incorporate the evidence-based practices of family-based treatment (FBT) into higher levels of care, such as day-treatment programs. This study tracked the effects of integrating the principles and strategies of FBT into a partial hospitalization program (PHP) for youth with eating disorders. Following retrospective chart review, rates of readmission to the PHP were measured for three years before (2011-2014) and after (2014-2017) FBT was incorporated into the hospital programming. Patients (N = 326) were primarily adolescents with anorexia nervosa. Rates of readmission were significantly lower for those who received care during the implementation of FBT-based PHP programming (2.95%) as compared to the prior traditional PHP (11.7%). Patterns of readmission to the PHP before and after FBT implementation suggest that FBT can be adapted for higher levels of care, and may reduce readmissions and promote continuity of care.
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Affiliation(s)
- Kathryn M Huryk
- Department is School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA
| | - Arielle F Casasnovas
- Department is School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA
| | - Meghan Feehan
- Pediatric Eating Disorders Center at Atlantic Health System, Summit, New Jersey, USA
| | - Katherine Paseka
- Pediatric Eating Disorders Center at Atlantic Health System, Summit, New Jersey, USA
| | - Patricia Gazzola
- Pediatric Eating Disorders Center at Atlantic Health System, Summit, New Jersey, USA
| | - Katharine L Loeb
- Department is School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA
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7
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Nilsen JV, Hage TW, Rø Ø, Halvorsen I, Oddli HW. Family-based inpatient treatment for adolescent anorexia nervosa: a thematic analysis of former patients' post-treatment reflections. Eat Disord 2021; 29:390-407. [PMID: 31682534 DOI: 10.1080/10640266.2019.1656469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study investigated former patients' experiences with family-based inpatient treatment. Interviews of thirty-seven patients diagnosed with anorexia nervosa during the admissions were conducted to examine their post-treatment perspectives. The accounts were analyzed by utilizing an inductive thematic analytic approach. The analysis yielded 4 main themes, constituted by in all 8 subthemes. The main themes were; 1) Enabling new ways of understanding and relating, 2) Enhancing or maintaining negative power dynamics, 3) Vulnerable transitions, and 4) Sibling relationships and different ways of involvement. With its "insider focus," this study contributes to knowledge on how family-based inpatient treatment is perceived from a user perspective. The current study has value for both advancing the development of family-based inpatient treatment, and by adding patient perspectives to the ongoing effort of providing family-based approaches at higher levels of care.
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Affiliation(s)
- Jan-Vegard Nilsen
- Department of Psychology, University of Oslo and Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Trine Wiig Hage
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Halvorsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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8
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Baudinet J, Simic M. Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review. Front Psychiatry 2021; 12:652604. [PMID: 33995149 PMCID: PMC8116630 DOI: 10.3389/fpsyt.2021.652604] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Adolescent eating disorder day programmes (DP), or partial hospitalization programs, are becoming increasingly widespread worldwide. They typically function as an alternative to inpatient care and/or a step up or down in treatment intensity. There has been an increase in the number of publications within the last 5 years investigating DP outcomes. While there are now numerous programmes operating internationally, there is large variability in the content, structure and theoretical underpinnings of each programme. This makes it difficult to compare programme outcomes, and the impact the therapeutic model may have. Aims: To review existing literature on adolescent eating disorder DP treatment models and outcomes. Methods: A systematic scoping review was conducted. Four databases (PsychInfo, EMBASE, Medline, CENTRAL) were searched for relevant peer-reviewed journal articles and book chapters investigating adolescent eating disorder DPs that function as alternatives to inpatient treatment. No restrictions on study methodology were imposed. Studies were first mapped by location, study characteristics and day programme treatment characteristics, then narratively synthesized. Results: Forty nine studies were included in this review. All used a quantitative methodology. One study also included qualitative methods. The majority of studies included describe DPs in the USA (69%). Seventy-six percent of the studies described DPs that operate 5-days per week and most (57%) either only admit or only report on outcomes for restrictive eating disorders. Two-thirds (69%) reported on DPs that had a family focused treatment model, the remainder had a more integrated treatment model informed mostly by individual psychotherapeutic models. Generally, DP treatment is associated with weight gain and improvements in eating disorder and comorbid psychopathology. The studies that include follow-up data (27%) reveal improvements are usually maintained from 3 months to 2 years post-treatment. Early weight gain, early psychological change and early therapeutic alliance are associated with improved end of treatment outcomes. Findings regarding other potential predictors of outcome are mixed. Conclusions: Current evidence suggests day programmes are an effective alternative to inpatient treatment that lead to sustained improvements. DPs tend to either be young-person-only with a family-focused treatment model or all age with a more integrative model. Controlled, empirical investigations into the impact of the therapeutic model on outcomes are needed, as are investigations into treatment mechanisms and the individual and parent experience of day programme treatment.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London, United Kingdom
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9
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Wallin U, Holmer R. Long-Term Outcome of Adolescent Anorexia Nervosa: Family Treatment Apartments Compared With Child Psychiatric Inpatient Treatment. Front Psychiatry 2021; 12:640622. [PMID: 34079480 PMCID: PMC8165165 DOI: 10.3389/fpsyt.2021.640622] [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: 12/11/2020] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The family is rarely involved in treatment when the patient with anorexia nervosa (AN) is hospitalized. Family treatment apartment (FTA) represents an intervention that includes the family in the intensive treatment of AN. This study compares the short- and long-term outcomes of adolescents treated in FTA with those who received inpatient hospital care. In FTA, the parents are responsible for providing meal support, whereas in hospital care, the staff is responsible. Methods: Sixty-eight previous patients admitted during the period 1990-2009 participated in a follow-up, 43 from the FTA where the whole family is admitted for treatment and 25 from regular psychiatric inpatient care. The follow-up consisted of a personal meeting with structured interviews, measurement of height and weight, and self-rating questionnaires. Result: Readmissions due to weight loss within 6 months from discharge were less common in the FTA group. At follow-up, 14.2 years after admission, there was no difference in eating disorder pathology between the groups. There were significantly lower scores on general psychiatric pathology and significantly higher scores on quality of life in the FTA group. Discussion: The treatment in FTA aims to give the family the ability to handle AN when it is most challenging. FTA may thus provide a helpful context for treatment with a basic sense of security along with skills that could contribute to better general mental health at follow-up.
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Affiliation(s)
- Ulf Wallin
- Centre of Eating Disorders, Psychiatry Skåne, Lund, Sweden
| | - Riitta Holmer
- Centre of Eating Disorders, Psychiatry Skåne, Lund, Sweden
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10
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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11
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Baudinet J, Simic M, Griffiths H, Donnelly C, Stewart C, Goddard E. Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord 2020; 8:68. [PMID: 33292696 PMCID: PMC7663904 DOI: 10.1186/s40337-020-00338-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. METHOD Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. RESULTS Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = -.67), reward responsivity (r = -.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. CONCLUSIONS This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK.
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Helena Griffiths
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Cecily Donnelly
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Catherine Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
| | - Elizabeth Goddard
- Maudsley Centre for Child and Adolescent Eating Disorders, Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE8 5AZ, UK
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12
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Combining day treatment and outpatient treatment for eating disorders: findings from a naturalistic setting. Eat Weight Disord 2020; 25:519-530. [PMID: 30706362 DOI: 10.1007/s40519-019-00643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. PURPOSE We investigated the long-term effectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. METHODS We accepted 148 patients with different diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. RESULTS Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients significantly improved with large effect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. CONCLUSIONS Our findings add to the existing studies on day treatment and support previously found encouraging effects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. LEVEL OF EVIDENCE Level III, longitudinal cohort study.
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13
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Reilly EE, Rockwell RE, Ramirez AL, Anderson LK, Brown TA, Wierenga CE, Kaye WH. Naturalistic outcomes for a day-hospital programme in a mixed diagnostic sample of adolescents with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:199-210. [PMID: 31925866 DOI: 10.1002/erv.2716] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/07/2019] [Accepted: 12/09/2019] [Indexed: 01/04/2023]
Abstract
Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry, University of California, San Diego, CA.,Department of Psychology, Hofstra University, Hempstead, NY
| | | | - Ana L Ramirez
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, CA.,VA San Diego Healthcare System, San Diego, CA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA
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14
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Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 2020; 8:4. [PMID: 32021688 PMCID: PMC6995106 DOI: 10.1186/s40337-020-0277-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, Canada
| | - Catherine Miller
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | | | | | | - Catherine Ford
- 9Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Kerry Bourret
- 10St. Joseph's Care Group - Thunder Bay, Thunder Bay, Canada
| | | | - Josie Geller
- 6The Univeristy of British Columbia, Vancouver, Canada
| | | | | | - Jennifer Scarborough
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
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15
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Abstract
Eating disorders are serious psychiatric illnesses with high rates of morbidity and mortality. Effective treatments have traditionally included behaviorally focused therapies as well as several medication strategies. Recent years have seen promising developments in these treatments, including additional support for family-based approaches for children and adolescents, new evidence for "third-wave" behavioral therapies, and new support for the use of lisdexamfetamine for binge eating disorder and olanzapine for anorexia nervosa. Case study and pilot data are beginning to show limited support for neuromodulatory interventions targeting brain regions thought to be involved in eating disorders. This review summarizes treatment developments over the last several years and points towards future directions for the field.
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Affiliation(s)
- Lauren E. Davis
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
- Weill Cornell Medical Center, New York, USA
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16
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Martin-Wagar CA, Holmes S, Bhatnagar KAC. Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa. Eat Disord 2019; 27:400-417. [PMID: 30358497 DOI: 10.1080/10640266.2018.1528085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.
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Affiliation(s)
| | - Samantha Holmes
- a Department of Psychology , University of Akron , Ohio , USA
| | - Kelly A C Bhatnagar
- b Department of Psychological Sciences , The Center for Evidence Based Treatment-Ohio & Case Western Reserve University , Ohio , USA
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17
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Wufong E, Rhodes P, Conti J. "We don't really know what else we can do": Parent experiences when adolescent distress persists after the Maudsley and family-based therapies for anorexia nervosa. J Eat Disord 2019; 7:5. [PMID: 30805186 PMCID: PMC6373134 DOI: 10.1186/s40337-019-0235-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/21/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Maudsley Family Therapy (MFT), and its manualised version, Family-Based Therapy (FBT), are the only well-established treatment interventions for adolescent anorexia nervosa (AN), with treatment efficacy primarily measured by improvements in eating behaviours and weight restoration. A crucial component of this therapy is an intensive home-based refeeding intervention that requires a substantial commitment from parents for up to one year. While this treatment works to restore weight in a proportion of adolescents, very little is known about its impacts on family distress, relationships and identity, including in the 40% of families where the adolescent experiences ongoing eating disorder (ED) symptomatology and/or psychological distress during and post-treatment. Specifically, few studies have investigated the impacts of MFT/FBT treatment on family functioning or on how parents negotiate their identities, or who they understand themselves to be, in the context of this treatment intervention. This is a significant omission, given the substantive role assigned to parents to take responsibility for their child's eating restoration in the first treatment phase. This study seeks to address this gap through a qualitative exploration of parents' experiences of MFT/FBT, in cases where treatment was discontinued and/or their child continued to experience psychological distress post-treatment. METHODS 13 parents participated in in-depth semi-structured interviews that scaffolded between their experiences and ways they negotiated and sustained their identities as parents within the context of MFT/FBT for their child. Interview data was analysed through a framework of critical discursive analysis to generate themes centred on these parents' experiences and identity negotiation. RESULTS Key findings are that MFT/FBT: (1) provided a map for therapy that initially relieved parents' anxieties for their child and facilitated improvements in family functioning; (2) inadequately addressed parental guilt and blame with a form of externalisation of the illness; (3) perpetuated parental guilt by raising anxiety about AN and allocating responsibility for refeeding their child in phase 1 of the treatment; and (4) when ceased, left these parents struggling with an uncertain future, and fears for the wellbeing of their children. CONCLUSIONS The structure of MFT/FBT provided initial relief with some improvements in family communication patterns, however, when the adolescent experienced protracted ED symptoms and/or ongoing psychological distress post-treatment, these parents were left with uncertainty as to how to navigate their shifting roles and their child's ongoing struggles. This research highlights the need for treatments for adolescent AN that more comprehensively address both the adolescent and parents' psychological distress and also (re)build their senses of identity that have been challenged by AN and its effects.
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Affiliation(s)
- Ella Wufong
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
| | - Paul Rhodes
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
| | - Janet Conti
- Western Sydney University, Locked Bag 1797, Penrith, 2751 Australia
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18
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Simic M, Stewart CS, Eisler I, Baudinet J, Hunt K, O'Brien J, McDermott B. Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder. Int J Eat Disord 2018; 51:1261-1269. [PMID: 30265750 DOI: 10.1002/eat.22959] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family Therapy for Anorexia Nervosa (FT-AN) is the first line treatment for adolescents with anorexia nervosa in the UK. However, research suggests between 10 and 40% of young people have a poor outcome. For those for whom FT-AN alone is not effective there is a clear need to develop additional treatments. This paper describes the effectiveness of an additional treatment for adolescents who had not responded to FT-AN, the Intensive Day Treatment Program (ITP) embedded within a comprehensive outpatient service at the Maudsley Hospital. METHOD Data from a retrospective chart review of patient files were analyzed for 105 young people aged 11-18 with restrictive eating disorders referred to the program in the first four and a half years of its operation. RESULTS Young people attended ITP for only on average 28.41 days. Over this time they made significant improvements in a range of domains, including weight gain, eating disorder symptomatology, motivation to recover, quality of life and comorbid symptomatology. Young people continued to make improvements post ITP in outpatient treatment provided by the same service and 73.2% had a good or an intermediate outcome at the point of discharge from the service. DISCUSSION This uncontrolled case series indicates that ITP can contribute to positive outcomes for young people who require intensification of treatment. ITP outcomes are discussed in comparison to the published literature concerning day programs for adolescents with a diagnosis of an eating disorder.
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Affiliation(s)
- Mima Simic
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Catherine S Stewart
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ivan Eisler
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Julian Baudinet
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katrina Hunt
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jayne O'Brien
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Beth McDermott
- National and Specialist Child and Adolescent Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Northamptonshire Community Eating Disorder Team, Northamptonshire Healthcare NHS Foundation Trust, Northampton, United Kingdom
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19
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Berona J, Richmond R, Rienecke RD. Heterogeneous weight restoration trajectories during partial hospitalization treatment for anorexia nervosa. Int J Eat Disord 2018; 51:914-920. [PMID: 30058155 DOI: 10.1002/eat.22922] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
Abstract
UNLABELLED Early response to treatment has been shown to predict good outcome in family-based treatment, but little is known about who responds quickly. OBJECTIVE The purpose of the current study was to examine the short-term weight gain trajectories among youth receiving partial hospitalization program services for anorexia nervosa (AN), and to identify predictors of these trajectories. METHOD Adolescent and young adults (n = 102) with AN or subthreshold AN completed semi-structured interviews and self-report measures on admission to a family-based partial hospitalization program. Patients participated in programming 5 days a week. RESULTS Three weight gain trajectories were found to indicate slow, moderate, and rapid weight gain trajectories. All rapid responders gained at least four lbs. in the first 4 weeks of treatment, compared to 86.1% of moderate responders and 51.2% of slow responders. Patients were less likely to have a moderate or rapid response trajectory if they had a mood disorder diagnosis and higher parental expressed emotion. Additionally, the presence of compensatory behavior increased the likelihood of having a rapid response. DISCUSSION Despite the sometimes chronic nature of AN, most patients fell into one of the two favorable response trajectories. The identification of these trajectories underscores the importance of considering the core disordered eating behaviors (i.e., restricting, binge eating, and purging), comorbid psychopathology, and parental expressed emotion.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Rebekah Richmond
- MUSC Friedman Center for Eating Disorders, Medical University of South Carolina, Charleston, South Carolina
| | - Renee D Rienecke
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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20
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Matthews A, Peterson CM, Peugh J, Mitan L. An intensive family-based treatment guided intervention for medically hospitalized youth with anorexia nervosa: Parental self-efficacy and weight-related outcomes. EUROPEAN EATING DISORDERS REVIEW 2018; 27:67-75. [PMID: 30062744 DOI: 10.1002/erv.2632] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/23/2018] [Accepted: 06/17/2018] [Indexed: 11/08/2022]
Abstract
Recent studies suggest the efficacy of family-based treatment (FBT) among youth with anorexia nervosa (AN) in intensive treatment settings. This study aimed to assess weight outcomes in youth who received an FBT intervention while hospitalized for medical complications of AN. Parental self-efficacy among participating caregivers was also measured. Post-discharge weights of 49 participants were compared with weights of 44 youth who were hospitalized prior to the provision of the FBT intervention. Youth who received the FBT intervention gained significantly more weight than youth in the retrospective treatment as usual group at 3 and 6 months following discharge. FBT youth were 2.84 times more likely than retrospective treatment as usual youth to achieve at least 95% of treatment goal weight at 6 months post-discharge. Finally, parental self-efficacy significantly increased in caregivers who participated in the FBT intervention. Findings provided preliminary support for the provision of FBT to medically hospitalized youth with AN.
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Affiliation(s)
- Abigail Matthews
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Laurie Mitan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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21
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Abstract
Family-based treatment principles have been incorporated into higher levels of care. However, outcome data for these programs, and, in particular, follow-up data, are limited. The current study assessed 3-month follow-up data for patients in a family-based partial hospitalization/intensive outpatient program. Patients completed measures of eating disorder psychopathology and depression, while parents completed measures of self-efficacy and expressed emotion. With the exception of paternal self-efficacy, all measures stayed the same or improved between end of treatment and follow-up, suggesting that improvements in a family-based higher level of care can be sustained once families step down to less intensive treatment.
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Affiliation(s)
- Renee D Rienecke
- a Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.,b Department of Pediatrics , Medical University of South Carolina , Charleston , SC , USA.,c Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina , Charleston , SC , USA
| | - Rebekah L Richmond
- d MUSC Friedman Center for Eating Disorders , Medical University of South Carolina , Charleston , SC , USA
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22
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Richards IL, Subar A, Touyz S, Rhodes P. Augmentative Approaches in Family-Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2017; 26:92-111. [PMID: 29282801 DOI: 10.1002/erv.2577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review the literature reporting outcomes of augmentative family-based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs). METHOD Articles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database). RESULTS Thirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end-of-treatment, although few compared augmentative and standard FBT interventions and good quality follow-up data was generally lacking. CONCLUSIONS There is early evidence for the effectiveness of augmentative FBT-based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Imogen Lim Richards
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Anni Subar
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Paul Rhodes
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
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23
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Halvorsen I, Reas DL, Nilsen JV, Rø Ø. Naturalistic Outcome of Family-Based Inpatient Treatment for Adolescents with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 26:141-145. [PMID: 29218761 DOI: 10.1002/erv.2572] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/23/2017] [Accepted: 11/11/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Outpatient family-based treatment (FBT) is the best-documented treatment for adolescent anorexia nervosa (AN), but research is scarce on FBT adapted to inpatient settings. AIM The naturalistic outcome of inpatient FBT for adolescent AN was investigated. METHODS Thirty-seven (65%) of 57 patients who received inpatient FBT at a tertiary adolescent eating disorders (ED) unit participated in a follow-up interview (mean 4.5 ± 1.8, range 1-7 years) that assessed ED symptoms and general psychological functioning. RESULTS A majority (65%) had achieved a normal body weight (body mass index ≥18.5). Thirty-six per cent (n = 12) were classified as fully recovered, as defined by body mass index ≥18.5, ED Examination Questionnaire global ≤2.5, and no binge eating/purging over past 3 months. Sixteen (43%) participants met criteria for one or more additional comorbid disorders. CONCLUSION Inpatient family-based therapy for AN may be a promising therapeutic approach for adolescents that fail to respond to outpatient treatment and should be investigated further. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Inger Halvorsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway
| | - Jan-Vegard Nilsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Norway
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24
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Rienecke RD. Family-based treatment of eating disorders in adolescents: current insights. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:69-79. [PMID: 28615982 PMCID: PMC5459462 DOI: 10.2147/ahmt.s115775] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.
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Affiliation(s)
- Renee D Rienecke
- Department of Pediatrics.,Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
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25
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Friedman K, Ramirez AL, Murray SB, Anderson LK, Cusack A, Boutelle KN, Kaye WH. A Narrative Review of Outcome Studies for Residential and Partial Hospital-based Treatment of Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2016; 24:263-76. [PMID: 27062687 DOI: 10.1002/erv.2449] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/23/2016] [Accepted: 03/05/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this study was to review the current eating disorders outcome literature after residential or partial hospitalization programme (PHP) treatment. METHOD Articles were identified through a systematic search of PubMed and PsycINFO. RESULTS Twenty-two PHP and six residential treatment studies reported response at discharge and tended to find improvement. Fewer studies (nine PHP and three residential) reported outcome at some interval after discharge from treatment. These tended to find sustained improvement. A substantial proportion of patients were lost to follow-up, particularly for residential treatment. Only two follow-up studies used controlled trials; both showed efficacy for PHP compared with inpatient treatment with regard to maintaining symptom remission. CONCLUSIONS Improvement at discharge may not predict long-term outcome. Long-term follow-up studies were confounded by high dropout rates. While higher levels of care may be essential for reversing malnutrition, there remains a lack of controlled trials showing long-term efficacy, particularly for residential treatment settings. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
| | - Ana L Ramirez
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Diego, CA, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Kerri N Boutelle
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
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26
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Murray SB, Anderson LK, Rockwell R, Griffiths S, Le Grange D, Kaye WH. Adapting Family-Based Treatment for Adolescent Anorexia Nervosa Across Higher Levels of Patient Care. Eat Disord 2015; 23:302-14. [PMID: 26011736 DOI: 10.1080/10640266.2015.1042317] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An increasing body of evidence supports the use of family-based treatment (FBT) in medically stable outpatient presentations of adolescent anorexia nervosa, although there is relatively less research on adapting evidence-based treatment approaches in more intensive levels of patient care. The integration of FBT, which centrally leverages parental involvement in more intensive levels of care which typically require greater clinical management, requires careful consideration. We provide an overview of several key practical and theoretical considerations when adjusting the delivery of FBT across more intensive levels of patient care, providing clinical guidelines for the delivery of FBT while ensuring fidelity to the core theoretical tenets. Implications for clinical practice and future research are discussed.
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Affiliation(s)
- Stuart B Murray
- a Department of Psychiatry , University of California, San Diego , San Diego , California , USA
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