Long-Term Effects of a Multidisciplinary Residential Treatment Model on Improvements of Symptoms and Weight in Adolescents With Eating Disorders

The sequential approach in eating disorders: A scoping systematic review

OBJECTIVE

The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs.

METHOD

Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded.

RESULTS

A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines.

CONCLUSIONS

The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.

Effectiveness of integrated treatment for eating disorders in Spain: protocol for a multicentre, naturalistic, observational study

INTRODUCTION

Eating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves.

METHODS AND ANALYSIS

This protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models.

ETHICS AND DISSEMINATION

The study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED.

TRIAL REGISTRATION NUMBER

NCT04127214.

Identification and Management of Eating Disorders in Children and Adolescents

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.

Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up

PURPOSE

The present study evaluated the statistical and clinical significance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may affect therapeutic outcomes.

METHODS

A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specific symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients filled out the same questionnaires at a 6-month follow-up after discharge.

RESULTS

Findings evidenced statistically significant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2-54.2% at the 6-month follow-up showed clinically significant symptomatic change; additionally, 19.8-29.1% of patients at discharge and 22.9-38.3% at follow-up improved reliably. However, 34.9-39.8% remained unchanged and 2-4.8% worsened. At the 6-month follow-up, 21.3-25.9% showed no symptomatic change and 0-3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to suffer a comorbid personality pathology and to be following concurrent pharmacological treatment.

CONCLUSIONS

Results suggested that intensive and multimodal residential treatment may be effective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology.

LEVEL OF EVIDENCE

Level III, evidence obtained from a longitudinal cohort study.

Demographics and Outcomes of Patients With Eating Disorders Treated in Residential Care

The use of residential eating disorder (ED) treatment has grown dramatically in the United States, yet there has been minimal evaluation of treatment outcomes. Thus, outcome data on weight restoration, purging behaviors, and/or Global Assessment of Functioning (GAF) for 1,421 patients treated over an 8-year period in residential ED programs are described. Results suggest that, (1) for patients who needed weight restoration upon admission, adolescent and adult patients gained 2.0 and 2.1 lb/week, respectively; (2) of patients who reported purge behavior the month before admission, 89.1% were able to completely cease purging while in treatment; (3) although improvement of approximately 10 mean GAF points was made during treatment, patients were still quite impaired at discharge; and (4) mean length of stay was 12 days longer for adolescents than adults, and 10–15 days longer for patients diagnosed with anorexia compared to bulimia or ED Not Otherwise Specified (EDNOS), respectively. Other demographic statistics and additional analyses are presented. Limitations include the high variance of purging data and reliance on self- and parent-report for admission data. The data on the 1,421 patients, which represents 96% of all patients treated during the study period, more than doubles the number of residential ED patients with outcome in the literature.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

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.

A Narrative Review of Outcome Studies for Residential and Partial Hospital-based Treatment of Eating Disorders

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.