1
|
Mills R, Hyam L, Schmidt U. Early intervention for eating disorders. Curr Opin Psychiatry 2024:00001504-990000000-00136. [PMID: 39146555 DOI: 10.1097/yco.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Research on early intervention for eating disorders has started to gain traction and examples of this in practice are increasing. This review summarizes findings over the past 3 years, focusing on the clinical effectiveness of early intervention in practice and the barriers and facilitators to its implementation. RECENT FINDINGS Recent developments in early intervention for eating disorders can be divided into three broad themes: research that has examined the efficacy of early intervention pathways in practice, research that has informed understanding of the target patient groups of early intervention (via clinical staging models, e.g.), and research that has suggested new ways to progress early intervention, towards becoming a standard part of best practice care. SUMMARY Early intervention pathways have shown promising clinical outcomes and are viewed positively by patients, clinicians and other stakeholders. However, more robust trials of their efficacy, effectiveness and cost-effectiveness are needed. Additionally, barriers to early intervention have been identified (e.g. delayed help-seeking); research must now develop and evaluate strategies to address these. Finally, the early intervention models in practice are underpinned partly by clinical staging models for eating disorders, which require further development, especially for eating disorders other than anorexia nervosa.
Collapse
Affiliation(s)
- Regan Mills
- Department of Clinical, Education and Health Psychology, University College London
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience
| | - Lucy Hyam
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience
- Eating Disorders Outpatient Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
2
|
Roff C, Cook-Cottone C. Assisted death in eating disorders: a systematic review of cases and clinical rationales. Front Psychiatry 2024; 15:1431771. [PMID: 39143961 PMCID: PMC11322357 DOI: 10.3389/fpsyt.2024.1431771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
Background Assisted dying for reasons solely related to an eating disorder (ED) has occurred in multiple countries, including those which restrict the practice to individuals with a terminal condition. The aims of this systematic review were to (1) identify all known cases of assisted deaths among patients with EDs and (2) describe the clinical rationales used to grant patients' requests for assisted death. Methods We conducted a systematic search of peer-reviewed studies and publicly available government reports to identify cases of assisted death in patients with EDs. In reports that included qualitative data about the case, clinical rationales were extracted and grouped into domains by qualitative content analysis. Results We identified 10 peer-reviewed articles and 20 government reports describing at least 60 patients with EDs who underwent assisted dying between 2012 and 2024. Clinical rationales were categorized into three domains: irremediability, terminality, and voluntary request. Reports emphasized that patients with EDs who underwent assisted death had terminal, incurable, and/or untreatable conditions and had adequate decision-making capacity to make a life-ending decision. Most government reports did not include descriptive-enough data to verify psychiatric conditions. Conclusion The results of our systematic review underscore considerable gaps in the reporting of assisted death in patients with psychiatric conditions, posing substantial concerns about oversight and public safety. In many cases, the clinical rationales that were used to affirm patients with EDs were eligible for assisted death lack validity and do not cohere with empirical understanding.
Collapse
Affiliation(s)
| | - Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
3
|
Tomba E, Tecuta L, Gardini V, Tomei G, Lo Dato E. Staging models in eating disorders: A systematic scoping review of the literature. Compr Psychiatry 2024; 131:152468. [PMID: 38460478 DOI: 10.1016/j.comppsych.2024.152468] [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: 01/11/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.
Collapse
Affiliation(s)
- E Tomba
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - L Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | - V Gardini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - G Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | - E Lo Dato
- Department of Psychology, University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Ålgars M, Oshukova S, Suokas J. A novel outpatient treatment model for patients with severe and enduring anorexia nervosa: an observational study of patient characteristics, treatment goals, and treatment course. J Eat Disord 2023; 11:150. [PMID: 37674214 PMCID: PMC10481592 DOI: 10.1186/s40337-023-00877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Approximately 20-30% of people with anorexia nervosa develop an enduring form of the disorder. In the present study a newly developed outpatient treatment unit for patients with severe and enduring anorexia nervosa was described. The treatment model is flexible, patient-centered, and aims at enhancing quality of life, maintaining medical stability, and minimizing harm. Treatment contents, patient characteristics, treatment goals, and course of treatment from the first five years of operation were described and analyzed. METHODS The participants (N = 22) consisted of all referrals resulting in an assessment or treatment period at the unit between May 2017 and May 2022. All participants were women. The study was a registry study. Information regarding patient characteristics, treatment goals, and the course of treatment was gathered from medical records. RESULTS On average, the participants had had a diagnosed eating disorder for 12.80 years, and self-reported eating disorder symptoms for 19 years. Their symptomatology included severe eating disorder symptoms, psychiatric comorbidities, extreme underweight, and co-occurring medical conditions. Their treatment goals commonly concerned improving physical health, reducing eating disorder symptoms, improving psychological well-being, and improving quality of life. The majority of participants for whom this information was available benefited from the treatment (60%) and their treatment goals were met or partly met (66.6%), as measured by evaluations made by the patient or the treatment team. More than two thirds (69.2%) of the participants for whom this information was available remained weight stable or showed an increase in BMI. CONCLUSIONS This observational study suggests that many individuals with severe and enduring anorexia nervosa may benefit from flexible treatment, aiming at supporting quality of life. The results highlight the importance of coordinating and integrating the treatment of severe and enduring anorexia nervosa and co-occurring psychiatric disorders as well as medical complications. Further research and international dialogue about the how treatment for this vulnerable patient group should best be organized is called for. Trial registration Trial registration number: NCT05708404. Date of registration: 01/23/2023 (retrospectively registered).
Collapse
Affiliation(s)
- Monica Ålgars
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland.
- Department of Psychology, University of Helsinki, PB 21, 00014, Helsinki, Finland.
| | - Svetlana Oshukova
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland
| | - Jaana Suokas
- Eating Disorder Unit, HUS Helsinki University Hospital, PB 282, 00029, Helsinki, Finland
| |
Collapse
|
5
|
Bou Khalil R, Sultan A, Seneque M, Richa S, Lefebvre P, Renard E, Courtet P, Maimoun L, Guillaume S. Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study. Nutrients 2022; 14:2727. [PMID: 35807906 PMCID: PMC9269154 DOI: 10.3390/nu14132727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.
Collapse
Affiliation(s)
- Rami Bou Khalil
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Ariane Sultan
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Maude Seneque
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Laurent Maimoun
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295 Montpellier, France
| | - Sebastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| |
Collapse
|
6
|
Broomfield C, Rhodes P, Touyz S. Lived experience perspectives on labeling and defining long-standing anorexia nervosa. J Eat Disord 2021; 9:101. [PMID: 34391479 PMCID: PMC8364069 DOI: 10.1186/s40337-021-00457-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/03/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Since efforts to stage anorexia nervosa (AN) revealed the existence of various presentations, research into the long-standing subgroup has increased. A change in treatment has been proposed with the intention to use more effective evidence-based methods that target symptoms of the long-standing presentation and improve prognosis. A barrier in achieving this goal in both research and clinical contexts is the lack of a consistent label and definition. This makes the ability to assess, recruit and treat these presentations difficult. Investigations into how this subgroup may be differentiated from other stages of the disorder have included the opinions of practitioners and researchers with little consideration for the perspectives of individuals living with this illness. It was the aim of the current study to investigate lived experience perspectives on the way long-standing AN should be labeled and defined. METHODS Data were collected through a semi-structured interview within a narrative inquiry framework. This approach is beneficial when examining processes that occur over time, such as investigations into a long-term illness. A total of 11 women with a presentation of long-standing AN participated in an interview. Data were divided into two categories for analysis based on the association to labeling or defining the features of the long-standing AN illness. RESULTS Two labels emerged during the analysis with participants describing a preference for the use of 'severe and enduring' over 'chronic' when referring to their presentation of AN. When defining the illness, the most preferred criterion was illness duration with mixed perspectives for the use of previously failed treatment attempts. Participants described a consistent dislike for the use of low body weight as a feature in the defining of the illness. CONCLUSIONS The current study describes how individuals with a lived experience prefer to have the long-standing AN presentation labeled and defined. It is the hope of the authors that these insights will be adopted into any guidelines developed to ensure individuals most affected by this disorder have a voice and continue to be given the opportunity to contribute to topics related to their illness. Anorexia nervosa (AN) is a complex illness that has been divided into stages based on the severity of symptoms. Little is known about the AN stage that persists over lengthy periods of time with research pursuits underway to determine characteristics that allow this disorder to persevere. A barrier in researching and treating these individuals is the lack of a consistent label to refer to these presentations and criteria that will allow us to identify this stage of AN. The aim of the current study was to determine how individuals with a lived experience of long-standing AN prefer to have their illness labeled and defined. A total of 11 women who had experienced this stage of AN were interviewed with the majority of participants reporting to prefer the label 'severe and enduring' over the term 'chronic'. Additionally, most of the participants had a preference for defining their illness based on the duration of time the illness had persisted with mixed opinions for using the number of previously unsuccessful treatment attempts as criterion. The authors are hopeful that any guidelines established for labeling and defining long-standing AN will incorporate the perspectives of individuals with a lived experience of the illness.
Collapse
Affiliation(s)
- Catherine Broomfield
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Paul Rhodes
- School of Psychology, Griffith Taylor Building, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
7
|
Riquin E, Raynal A, Mattar L, Lalanne C, Hirot F, Huas C, Duclos J, Berthoz S, Godart N. Is the Severity of the Clinical Expression of Anorexia Nervosa Influenced by an Anxiety, Depressive, or Obsessive-Compulsive Comorbidity Over a Lifetime? Front Psychiatry 2021; 12:658416. [PMID: 34279519 PMCID: PMC8280337 DOI: 10.3389/fpsyt.2021.658416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: The relationship between anxiety or depressive comorbidities, their chronology of onset, and the severity of anorexia nervosa (AN) is not well-studied. We hypothesize that the existence of a comorbidity, particularly before the onset of AN, is associated with greater severity of AN. Methods: One hundred seventy-seven subjects were assessed. The prevalence of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and social phobia (SP) as well as their chronology of onset were studied. The assessment criteria of AN severity were the overall clinical condition, body mass index (BMI) on admission, lowest BMI, intensity of the eating symptoms, age at the onset of AN, illness duration, number of hospitalizations, and quality of life. Results: Patients with AN had the greatest clinical severity when they had a comorbid disorder over their lifetime, such as MDD, GAD, or SP. These comorbidities along with OCD were associated with a higher level of eating symptoms and a more altered quality of life. A profile of maximum severity was associated with a higher prevalence of MDD and GAD. Concerning the chronology of onset, the age at the start of AN was later in cases of MDD or GAD prior to AN. Conclusion: There seems to be an association between severity of AN and both MDD and GAD. The chronology of onset of the comorbidity did not seem to be associated with the severity.
Collapse
Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers [Angers University Hospital], Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Centre Pierre Daguet, Sablé-sur-Sarthe, France
| | - Agathe Raynal
- Department of Child and Adolescent Psychiatry, CH du Rouvray-CHU de Rouen, Rouen, France
| | - Lama Mattar
- Nutrition Division, Department of Natural Sciences, School of Arts and Sciences-Lebanese American University, Beirut, Lebanon
| | - Christophe Lalanne
- Université Paris Diderot [Paris Diderot University], Paris Sorbonne Cité, Paris, France
| | - France Hirot
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Caroline Huas
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
| | - Jeanne Duclos
- Univ. Lille, CNRS, CHU Lille, UMR 9193—SCALab—Cognitive and Affective Sciences, Lille, France
- Hôpital Saint Vincent de Paul, GHICL, Département de Psychiatrie, Paris, France
| | - Sylvie Berthoz
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Univ. Bordeaux INCIA CNRS UMR 5287, Bordeaux, France
| | - Nathalie Godart
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
- UFR des Sciences de la Santé Simone Veil [Simone Veil Health Science Training and Research Unit], Université de Versailles Saint-Quentin-en-Yvelines [Versailles Saint-Quentin-en-Yvelines University], Versailles, France
| |
Collapse
|
8
|
Steinglass JE, Glasofer DR, Dalack M, Attia E. Between wellness, relapse, and remission: Stages of illness in anorexia nervosa. Int J Eat Disord 2020; 53:1088-1096. [PMID: 32031292 PMCID: PMC7384605 DOI: 10.1002/eat.23237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
Collapse
Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Deborah R. Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Maya Dalack
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York,Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York
| |
Collapse
|
9
|
Austin A, Flynn M, Richards K, Hodsoll J, Duarte TA, Robinson P, Kelly J, Schmidt U. Duration of untreated eating disorder and relationship to outcomes: A systematic review of the literature. EUROPEAN EATING DISORDERS REVIEW 2020; 29:329-345. [DOI: 10.1002/erv.2745] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/21/2020] [Accepted: 04/30/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Amelia Austin
- Section of Eating Disorder Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Michaela Flynn
- Section of Eating Disorder Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Katie Richards
- Section of Eating Disorder Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - John Hodsoll
- Department of Biostatistics Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
| | - Tiago Antunes Duarte
- Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE Lisbon Portugal
| | - Paul Robinson
- Division of Medicine University College London London UK
| | | | - Ulrike Schmidt
- Section of Eating Disorder Institute of Psychiatry, Psychology and Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust London UK
| |
Collapse
|
10
|
Takakura S, Aso CS, Toda K, Hata T, Yamashita M, Sudo N. Physical and psychological aspects of anorexia nervosa based on duration of illness: a cross-sectional study. Biopsychosoc Med 2019; 13:32. [PMID: 31889996 PMCID: PMC6929428 DOI: 10.1186/s13030-019-0173-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background We evaluated physical and psychological features of patients with anorexia nervosa (AN) who differed by duration of illness. Methods Data were obtained from 204 female patients with AN, divided into two groups based on illness duration: short-term illness duration (less than 5 years; n = 118); and long-term duration (5 years or more; n = 86). Physical parameters were measured using blood serum testing and psychological aspects were assessed using various instruments. Results A significantly higher proportion of restricting type AN was observed in the short-term group while the proportion of binge eating/purging type AN was higher in the long-term group. There was no difference in body mass index (BMI) between the groups. Serum total protein, albumin, potassium, chloride, and calcium in the long-term group were significantly lower than in the short-term group. Overall scores on the Eating Disorder Inventory as well as most of the subscales, except maturity fears, were higher in the long-term group than in the short-term group. The care subscale of the Parental Bonding Instrument (PBI) was lower in the long-term group than in the short-term group, while the overprotection subscale of the PBI was higher in the long-term group than in the short-term group. Results of a multiple regression analysis indicated that the overprotection subscale of the PBI was the only significant predictor of duration of illness. Conclusions Duration of illness may be associated with physical and psychological features of AN; thus, adapting therapeutic approaches to illness duration might be necessary.
Collapse
Affiliation(s)
- Shu Takakura
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Chie Suzuyama Aso
- 2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kenta Toda
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Tomokazu Hata
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Makoto Yamashita
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan
| | - Nobuyuki Sudo
- 1Department of Psychosomatic Medicine, Kyushu University Hospital, 3-1-1 Maidashi, higashi-ku, Fukuoka, 812-8582 Japan.,2Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| |
Collapse
|
11
|
Tomba E, Tecuta L, Crocetti E, Squarcio F, Tomei G. Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta-analysis. Int J Eat Disord 2019; 52:759-776. [PMID: 31169332 DOI: 10.1002/eat.23095] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In psychiatry, the presence of residual symptoms after treatment is linked to the definitions of remission and recovery. To identify the presence of residual eating disorder (ED) symptoms and associated non-ED clinical features in remitted and recovered EDs, the current systematic review with meta-analysis was performed. METHOD A systematic review was conducted on residual ED symptoms and non-ED clinical features including comorbid psychopathology, neurophysiological functioning, cognitive functioning, and quality of life in ED patients considered remitted or recovered. To examine residual ED symptoms, meta-analyses were performed while considering age, study quality, remission, and recovery criteria strictness as moderators. Sensitivity, publication bias, and heterogeneity analyses were also conducted. RESULTS The 64 studies selected for the systematic review underscored the presence of residual ED symptoms in anorexia nervosa (AN) and bulimia nervosa (BN), and impairments and deficits in the additional features examined. From the 64 studies, 31 were selected regarding residual ED symptoms in AN for meta-analysis. Large effect sizes indicated that remitted/recovered AN patients reported significantly lower body mass index (Hedges' g = -0.62[-0.77, -0.46]) and significantly greater symptomatology in terms of ED examination-questionnaire (Hedges'g = 0.86 [0.48,1.23]) and ED inventory (Hedges' g = 0.94[0.64,1.24]) than healthy controls, independently of remission and recovery criteria strictness, age, and study quality. DISCUSSION The presence of residual ED symptoms in AN is quantitatively supported, whereas the presence of residual ED symptoms in BN should be further investigated. Data on binge-eating disorder are missing. Future research should use consistent, multicomponent, and standardized comparable indicators of recovery.
Collapse
Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Fabio Squarcio
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuliano Tomei
- Oxford Health NHS Foundation Trust, Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|