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Giel KE, Bremer J, Rieß-Stumm S, Gregg B, Fritz A, Klemm I, Daugelat MC, Schag K. Enriching a randomized controlled treatment trial for anorexia nervosa by lived experience-Chances and effects of a lived experience council in the SUSTAIN study. Int J Eat Disord 2024; 57:1300-1310. [PMID: 37712498 DOI: 10.1002/eat.24050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The development and advancement of treatment and care options is one priority in the field of eating disorders. The inclusion of persons with lived experience with eating disorders into clinical research could enrich and accelerate this endeavor, as they can add different perspectives on the disease and its treatment. Although lived experience perspectives are increasingly part of eating disorder research, they have not been widely or structurally implemented into clinical trials and there is limited information on the practice of participatory research, its framework and consequences. AIMS The present work outlines the participatory collaboration with a lived experience council in the randomized controlled treatment trial SUSTAIN. MATERIALS & METHODS The manuscript is a participatory publication co-written by individuals with lived experience with anorexia nervosa and eating disorder researchers. RESULTS We report on motivations for this approach, our collaboration principles, structures and shared experience of working together in the trial, the potential burdens and benefits related to participation for people with lived experience. DISCUSSION We outline future directions and perspectives to integrate a participatory framework into clinical eating disorder research. CONCLUSION The involvement of people with experiential knowledge is complex, but possible in clinical research on ED and bears huge potential for the development of more effective care. PUBLIC SIGNIFICANCE Incorporating perspectives of people with lived experience into a participatory framework of mental health research bears huge potential on a societal level. This includes more relevant research topics and designs, more tailored and effective interventions, and facilitated implementation, as well as dissemination, higher credibility, destigmatization of mental illness, and patient empowerment. Participatory clinical research, however, needs structural anchorage within science and society.
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Affiliation(s)
- Katrin Elisabeth Giel
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
- German Center for Mental Health (DZPG)
| | | | | | | | - Anke Fritz
- Lived experience representative SUSTAIN study
| | | | - Melissa-Claire Daugelat
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine und Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders (KOMET), Tübingen, Germany
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2
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Clark Bryan D, Rowlands K, Macdonald P, Cardi V, Ambwani S, Arcelus J, Landau S, Schmidt U, Treasure J. Transition support for patients admitted to intensive treatment for anorexia nervosa: qualitative study of patient and carer experiences of a hybrid online guided self-help intervention (ECHOMANTRA). BJPsych Open 2024; 10:e81. [PMID: 38623648 PMCID: PMC11060069 DOI: 10.1192/bjo.2023.642] [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: 02/17/2023] [Revised: 09/08/2023] [Accepted: 12/06/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Adults with anorexia nervosa experience high levels of relapse following in-patient treatment. ECHOMANTRA is a novel online aftercare intervention for patients and carers, which provides psychoeducation and support to augment usual care. AIMS To explore patient and carer experiences of receiving the ECHOMANTRA intervention. METHOD This is part of the process evaluation of the ECHOMANTRA intervention as delivered in the TRIANGLE trial (ISRCTN: 14644379). Semi-structured interviews were conducted with 20 participants randomised to the ECHOMANTRA (ten patients and ten carers). Thematic analysis was used to analyse the interview transcripts. RESULTS Five major themes were identified: (1) Mixed experience of the intervention; (2) tailoring the intervention to the stage of recovery; (3) involvement of carers; (4) acceptability of remote support; and (5) impact of self-monitoring and accountability. CONCLUSIONS Participants were mostly positive about the support offered. The challenges of using remote and group support were counterbalanced with ease of access to information when needed. Components of the ECHOMANTRA intervention have the potential to improve care for people with eating disorders.
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Affiliation(s)
- Danielle Clark Bryan
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katie Rowlands
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Valentina Cardi
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of General Psychology, University of Padova, Italy
| | - Suman Ambwani
- DIS Study Abroad in Scandinavia, Copenhagen, Denmark
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, UK; and Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Barcelona, Spain
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Meule A, Kolar DR, Naab S, Voderholzer U. Distance to home does not influence treatment success during and after inpatient treatment in adolescents with anorexia nervosa. Eur Child Adolesc Psychiatry 2023; 32:2667-2670. [PMID: 35674837 PMCID: PMC10682196 DOI: 10.1007/s00787-022-02013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
Current treatment guidelines recommend that inpatients with eating disorders-particularly adolescents with anorexia nervosa-should receive treatment at facilities within close distance to their home. However, whether distance to home actually influences short- and long-term treatment outcome in adolescents with anorexia nervosa has not been investigated yet. We re-analyzed data at admission, discharge, and 1-year follow up from a recent study with N = 142 female, adolescent inpatients with anorexia nervosa. Distance to home did not moderate changes in body weight, eating disorder symptoms, depressive symptoms, compulsive exercise, and life satisfaction. This is the first analysis that indicates that specialized inpatient treatment for adolescents with anorexia nervosa is effective both close to and away from home.
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Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany.
| | - David R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Silke Naab
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Germany
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Fitzsimmons-Craft EE, Laboe AA, McGinnis C, Firebaugh ML, Shah J, Wallendorf M, Jacobi C, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE. A pilot randomized controlled trial of a cognitive-behavioral therapy guided self-help mobile app for the post-acute treatment of anorexia nervosa: A registered report. Int J Eat Disord 2023; 56:654-661. [PMID: 36609861 PMCID: PMC10019771 DOI: 10.1002/eat.23891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.
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Affiliation(s)
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Pruccoli J, Chiavarino F, Nanni C, Parmeggiani A. General psychopathological symptoms in children, adolescents, and young adults with anorexia nervosa-a naturalistic study on follow-up and treatment. Eur J Pediatr 2023; 182:997-1007. [PMID: 36542163 PMCID: PMC9769464 DOI: 10.1007/s00431-022-04745-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Recent research has assessed the role of general psychopathological symptoms in the natural history of mental health conditions, including anorexia nervosa (AN) in adults and obesity in children. Nevertheless, literature assessing general psychopathological symptoms in young patients with AN and their potential prognostic role in long-term outcomes is lacking. Observational, naturalistic study, involving young patients hospitalized for AN. General psychopathological symptoms were assessed by administering Symptom Check List-90-R (SCL-90-R) at admission (T0) and discharge (T1). AN-specific psychopathology was assessed with Eating Disorders Inventory-3 Eating Disorder Risk (EDRC) and Body Uneasiness Test Global Severity Index (BUT-GSI). Potential T0-T1 modifications of general psychopathological symptoms and their possible associations with baseline psychopathological, weight, and psychopharmacological variables were assessed with a generalized linear model (GLM), corrected for baseline SCL-90-R scores. Then, possible associations between T0 general psychopathological symptoms and the risk of re-hospitalization at 1 year were assessed with the Kaplan-Meier method and Cox regression. This study enrolled 133 patients (mean age 16.9 ± 2.9 years, F = 91.8%). A significant T0-T1 reduction (p < 0.001) in almost all the general psychopathological symptoms (except paranoia) emerged. The GLM revealed that higher EDI-3 EDRC scores were associated with higher T1 SCL-90-R scores in multiple domains. Cox regressions revealed a predictive role of SCL-90-R interpersonal sensitivity (B = 0.113, hazard ratio = 1.119, p = 0.023) on the risk of re-hospitalization at 1 year. Conclusion: General psychopathological symptoms in young patients with AN may be influenced by hospital treatment interventions and have a potential prognostic role on post-discharge outcomes. Further longitudinal studies are required. What is Known: • General psychopathological symptoms represent a relevant feature that clinicians should consider in the diagnosis, treatment, and prognosis of multiple psychiatric conditions. Co-occurring psychiatric comorbidities, moreover, have been documented to impact individuals diagnosed with Anorexia Nervosa (AN) in the developmental age. Despite this evidence, the literature lacks studies assessing the occurrence and impact of general psychopathological symptoms in young patients with AN. What is New: • The clinical picture of children, adolescents, and young adults with AN mays be impacted by multiple general psychopathological symptoms, including Somatization, Obsession-compulsion, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobia, Paranoia, and Psychoticism, which may improve with a multidisciplinary hospital intervention. The occurrence of these symptoms, particularly "interpersonal sensitivity", may negatively impact the prognosis of the affected patients.
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Affiliation(s)
- Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Via Massarenti 9, Bologna, 40138, Italy
| | - Francesca Chiavarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Via Massarenti 9, Bologna, 40138, Italy
| | - Camilla Nanni
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Via Massarenti 9, Bologna, 40138, Italy
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'Età Pediatrica, Centro Regionale per i Disturbi della Nutrizione e dell'Alimentazione in età evolutiva, Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, Via Massarenti 9, Bologna, 40138, Italy.
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Giel K, Bremer J, Zipfel S. Partizipativ mit unseren PatientInnen für bessere Therapie
und Versorgung forschen – Patient & Public Involvement (PPI) in
der Psychosomatischen Medizin. Psychother Psychosom Med Psychol 2023; 73:7-8. [PMID: 36623532 DOI: 10.1055/a-1980-7300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Unter dem Schlagwort Patient & Public Involvement (PPI) gewinnt der
Einbezug von Menschen, die direkt oder indirekt von einem spezifischen Themenfeld
oder einer Erkrankung betroffen sind, zunehmend an Bedeutung. Bezogen auf
Gesundheitsforschung und Medizin umfasst PPI die aktive und partnerschaftliche
Zusammenarbeit von WissenschaftlerInnen oder BehandlerInnen mit PatientInnen,
Angehörigen oder anderen Gesellschaftsmitgliedern in allen Phasen eines
partizipativen Forschungs- und Implementierungsprozesses. In einem
prägnanten Satz zusammengefasst: „Wir forschen nicht
über Menschen, sondern wir forschen gemeinsam mit
ihnen.“
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Affiliation(s)
- Katrin Giel
- Medizinische Universitätsklinik Tübingen, Psychosomatische Medizin und Psychotherapie.,Kompetenzzentrum für Essstörungen Tübingen
| | | | - Stephan Zipfel
- Medizinische Universitätsklinik Tübingen, Psychosomatische Medizin und Psychotherapie.,Kompetenzzentrum für Essstörungen Tübingen
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Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study. Eat Weight Disord 2022; 27:2213-2222. [PMID: 35133642 DOI: 10.1007/s40519-022-01365-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs. METHODS One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention. RESULTS Motivation and commitment to take active steps toward change (expressed by the "Committed Action" composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from "contemplation" to "action" stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment. CONCLUSION A single-day session devoted to experiencing a range of group psychotherapies increased patients' insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes. LEVEL OF EVIDENCE V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Clark Bryan D, Macdonald P, Cardi V, Rowlands K, Ambwani S, Arcelus J, Bonin EM, Landau S, Schmidt U, Treasure J. Transitions from intensive eating disorder treatment settings: qualitative investigation of the experiences and needs of adults with anorexia nervosa and their carers. BJPsych Open 2022; 8:e137. [PMID: 35856250 PMCID: PMC9347315 DOI: 10.1192/bjo.2022.535] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Relapse rates for individuals with anorexia nervosa after intensive hospital treatment (in-patient or full-time day care) are high. Better knowledge about the difficulties and opportunities that arise during this transition is needed to identify factors that support or hinder continued recovery upon discharge. AIMS The aim of this study was to explore the experiences of adult patients and their chosen carers on the process of transitioning from intensive eating disorder treatment settings to the community. METHOD Semi-structured interviews were conducted with patients with anorexia nervosa (n = 11) discharged from day or in-patient care from specialised eating disorder units across the UK, and their chosen carers (n = 20). Data were analysed with inductive thematic analysis. RESULTS Four interrelated themes were identified for both groups. For patients, themes were continuity of care, ambivalence about continued recovery, the value of social support and a call for enhanced transition support. For carers, themes were the impact of the eating disorder on themselves and the family, perceptions of recovery and support post-discharge, the impact of previous treatment and care experiences, and desire to create a supportive transition process. CONCLUSIONS The study provides an insight into the unique challenges that individuals with anorexia nervosa face upon leaving intensive treatment. A lack of post-discharge planning, support system and identity formation outside of anorexia nervosa were perceived as barriers to continued recovery. Patients and carers advocated for transition support that incorporates a phased, inclusive approach with accessible professional and social support in the community.
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Affiliation(s)
- Danielle Clark Bryan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of General Psychology, University of Padova, Italy
| | - Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Pennsylvania, USA
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, UK
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Ibrahim A, Ryan S, Viljoen D, Tutisani E, Gardner L, Collins L, Ayton A. Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings. J Eat Disord 2022; 10:98. [PMID: 35804403 PMCID: PMC9264571 DOI: 10.1186/s40337-022-00620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Inpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice. METHODS This is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6-8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay. RESULTS 212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18-60) years, mean admission BMI was 14.1 (10-18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ2 < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU. CONCLUSIONS Our main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.
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Affiliation(s)
- Ali Ibrahim
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sharon Ryan
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | | | - Lorna Collins
- Oxford Health NHS Foundation Trust, Oxford, UK.,Arts and Sciences, University College London, London, UK
| | - Agnes Ayton
- Oxford Health NHS Foundation Trust, Oxford, UK. .,Department of Psychiatry, University of Oxford, Oxford, UK.
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10
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Giel KE, Behrens SC, Schag K, Martus P, Herpertz S, Hofmann T, Skoda EM, Voderholzer U, von Wietersheim J, Wild B, Zeeck A, Schmidt U, Zipfel S, Junne F. Efficacy of post-inpatient aftercare treatments for anorexia nervosa: a systematic review of randomized controlled trials. J Eat Disord 2021; 9:129. [PMID: 34654471 PMCID: PMC8518230 DOI: 10.1186/s40337-021-00487-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early relapse after inpatient treatment is a serious problem in the management of anorexia nervosa (AN). Specialized aftercare interventions have the potential to bridge the gap between inpatient and outpatient care, to prevent relapse and to improve the long-term outcome for patients with AN. METHODS Following the guidelines of the PRISMA statement, we conducted a systematic review, synthesizing the evidence from randomized-controlled trials (RCTs) investigating the efficacy of post-inpatient aftercare treatments for AN. RESULTS Our search resulted in seven RCTs and three registered ongoing trials. Pharmacotherapy and low-threshold guided self-help have limited uptake and high dropout. Novel mobile guided self-help approaches seem promising due to high patient satisfaction, but their efficacy has yet to be investigated in larger trials. Cognitive-behavior psychotherapy may be beneficial in delaying relapse, but evidence is based on a single study. CONCLUSION Only a limited number of RCTs investigating aftercare interventions for patients with AN is available. There is no clear evidence favoring any one specific approach for post-inpatient aftercare in adult patients with AN. The field faces many challenges which generally affect intervention research in AN. A specific issue is how to increase uptake of and reduce dropout from aftercare interventions. This calls for better tailoring of interventions to patient needs and the integration of patient perspectives into treatment. Intensified research and care efforts are needed to address the problem of recurrent relapse after intensive inpatient treatment for AN and to eventually improve prognosis for this eating disorder.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University, Osianderstr. 5, 72076, Tübingen, Germany. .,Center of Excellence in Eating Disorders, Tübingen, Germany.
| | - Simone C Behrens
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University, Osianderstr. 5, 72076, Tübingen, Germany.,Center of Excellence in Eating Disorders, Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University, Osianderstr. 5, 72076, Tübingen, Germany.,Center of Excellence in Eating Disorders, Tübingen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department Psychiatry and Psychotherapy, University Hospital LMU Munich, Munich, Germany.,Department Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University, Osianderstr. 5, 72076, Tübingen, Germany.,Center of Excellence in Eating Disorders, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Eberhard Karls University, Osianderstr. 5, 72076, Tübingen, Germany.,Center of Excellence in Eating Disorders, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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