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Johnsen L, Bird JC, Salkovskis P, James AC, Stratford HJ, Sheaves B. Sleep disruption in adolescent inpatients: prevalence, associations with clinical outcomes, and clinician perspectives. J Sleep Res 2024; 33:e14056. [PMID: 37787462 DOI: 10.1111/jsr.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Sleep problems are common for adolescents with psychiatric disorders, and sleep treatment may aid mental health recovery. Inpatient admissions are likely a particularly challenging time for sleep. Despite this little is known about the nature of sleep problems, and how sleep treatments could be optimised for this setting. This mixed-methods study set out to better understand sleep disturbances in adolescent inpatients. Study 1 examined the prevalence of Sleep Condition Indicator-assessed insomnia at admission and associations with psychiatric symptoms and admission length in 100 inpatients (aged 11-17 years) on one unit in Oxford. Data were gathered from admission routine measures and medical records. Associations were analysed using linear regressions. Half of the inpatients (n = 50) screened positive for insomnia at admission. Moderate-large significant associations were observed between more severe insomnia and more severe depression (β = -0.56), anxiety (β = -0.51), self-harm (β = -0.49), psychotic experiences (β = -0.32), and conduct problems (β = -0.30), but not admission length. Study 2 gained 12 clinicians' perspectives on sleep problems on the unit via a focus group and semi-structured interviews, analysed using thematic analysis. Ward staff observed insomnia and excessive daytime sleepiness in adolescent inpatients and a reciprocal relationship with mental health symptoms. Ward processes were barriers (e.g., night-time observations) and facilitators (e.g., regular routines) of sleep. Cognitive behavioural therapy for insomnia was not routinely offered but viewed as potentially helpful. Insomnia may be a common problem for adolescent inpatients, associated with greater psychopathology, but not admission length. The possible benefits of psychological sleep interventions for adolescents admitted to psychiatric units now require testing.
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Affiliation(s)
- Laura Johnsen
- Berkshire Healthcare NHS Foundation Trust, Thatcham, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Salkovskis
- The Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Bryony Sheaves
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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2
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Corcoran R, Trainor G, Robinson B. The minority or the misunderstood? A young man's journey with anorexia nervosa. J Psychiatr Ment Health Nurs 2021; 28:760-772. [PMID: 34236744 DOI: 10.1111/jpm.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/17/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite findings that 1 in 4 eating disorder sufferers are male (Beat, 2017), they continue to be known as "female" disorders, an association which delays diagnosis in males and prevents them from seeking the help that they need to recover. AIM The current paper aimed to challenge this misconception by enabling and supporting Ben, a young male diagnosed with Anorexia Nervosa aged 16, to share his experience of seeking and receiving treatment for the disorder. METHOD It achieved this by exploring how his disorder developed, his experience of a child and adolescent inpatient service and the events leading up to this, and his life post-discharge, all in collaboration with Ben himself and using his own words. DISCUSSION The paper concludes with some implications for future practice, including that eating disorders should not be skewed towards any gender, treatment programmes need to ensure full inclusivity of males, and more gender sensitive information is required to raise awareness of this population and thus reduce the stigma and isolation they experience at present. It is hoped that these, along with the rest of the paper, will be accessible to and utilized by both professionals and non-professionals alike. ACCESSIBLE SUMMARY ● Around one quarter of people diagnosed with an eating disorder are male, yet they continue to be known as "female" disorders. Because of this, young males are often missed by the system and as a result, receive treatment later than they should. They are currently underrepresented in services. ● This paper challenges the association above by supporting a young man who suffered with a type of eating disorder known as Anorexia Nervosa to share his journey from his personal perspective. It provides great insight into what it is like to be a male with an eating disorder, including how it felt to be the only male in an inpatient facility surrounded by females with the same disorder. ● The paper also provides important information for professionals working in the area. For example, eating disorders, including Anorexia Nervosa, should not be associated with one specific gender, and treatment programmes for young people with eating disorders should ensure they are appropriate for both females and males. As a society, we need to challenge the stigma which exists for males in admitting when they are struggling and asking for help, and we need to do everything we can to ensure that young men are picked up earlier in the system, in order to give them the best chance of recovery. ● It is hoped that Ben's story and the recommendations from it can go on to help other males who might be struggling.
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Affiliation(s)
- Rachael Corcoran
- Manchester University NHS Foundation Trust, Manchester, Greater Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Gemma Trainor
- Liverpool John Moores University, Liverpool, Merseyside, United Kingdom of Great Britain and Northern Ireland
| | - Ben Robinson
- Wigan, Greater Manchester, United Kingdom of Great Britain and Northern Ireland
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Wambua GN, Kumar M, Falkenström F, Cuijpers P. Routine outcome measurement in adolescents seeking mental health services: standardization of HoNOSCA in Kenyan sample. BMC Psychiatry 2021; 21:440. [PMID: 34488702 PMCID: PMC8422761 DOI: 10.1186/s12888-021-03438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya. METHODS Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) were administered at the Youth Centre at the Kenyatta National Hospital in Nairobi. Initial ratings were obtained from adolescents 12-17 years (n = 201). A sample of 98 paired ratings with 2 follow-ups were examined for measurement of change over time. RESULTS Our findings showed good reliability with the self-rated version of the HoNOSCA score, correlating well with the self-reported version of the PSC (r = .74, p < .001). Both versions correlated well at follow-up and were sensitive to change. Using factor analysis, the maximum likelihood factoring and Promax rotation resulted in a four-factor structure, which with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.8 explained 54.74% of total variance. CONCLUSION The HoNOSCA appears to be of value, and easy to use in routine settings. Our findings suggest further investigation with a larger sample.
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Affiliation(s)
- Grace Nduku Wambua
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Fredrik Falkenström
- grid.5640.70000 0001 2162 9922Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Pim Cuijpers
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lascar R, Letranchant A, Hirot F, Godart N. [What factors explain the length of hospitalization for anorexia nervosa: A systematic review]. Encephale 2021; 47:362-368. [PMID: 33752870 DOI: 10.1016/j.encep.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The cost of hospital treatment for anorexia nervosa (AN) is very high given its duration. Identifying factors related to length of hospital stay (LOS) would make it possible to consider targeted therapeutic strategies that, by optimizing care, would reduce their duration and costs. The objective of this work is to identify the factors related (predictive and associated) to LOS for AN. METHODS Systematic review of existing literature up to October 2020, based on Pubmed, according to PRISMA recommendations (Preferred Reported Items for Systematic reviews and Meta-Analysis). Factors related to LOS have been described in two categories: factors related to clinical aspects ; and factors related to therapeutic aspects and management modalities. We distinguished predictive factors (identified as pre-hospitalization or contemporaneous with hospital admission) and associated factors (observed during hospitalization) for each category. RESULTS Thirteen articles were selected. Samples from the selected studies ranged from 35 to 381 subjects, mostly women with restrictive type AN (R-AN), but some samples included all types of AN, or focused on purging-type forms. The mean age at admission ranged from 13.6 years (Standard Deviation-SD:±1.6) to 30.3 years (SD :±13.9), corresponding to adolescent, adult or mixed samples. Mean body mass indices at admission ranged from 12.3 (SD±1.4) to 16.6 (SD:±2.1). The duration of disease progression ranged from 11.7 months±2.2 to 9.7 years. Mean LOS are short for studies conducted in pediatrics or in medical services (ranging from 13.0 days [SD±7.3] to 22.1 days [SD±9.4]); they are more variable for studies conducted in psychiatry: from 15.6 days (SD±1.0) to 150.2 days (SD±80.8). Among the factors related to an increase in LOS, clinical predictors included: older age at onset or admission; longer duration of the disorder; low minimum body weight during AN; low BMI at admission; purgative form of anorexia nervosa; and high levels of dietary symptoms (asceticism and ineffectiveness dimensions on Eating Disorder Inventory-2). Therapeutic and management modality predictive factors were: a higher number of hospitalizations for AN; the use of enteral nutrition (nasogastric or percutaneous gastric tube) on admission or during hospitalization; the use of intravenous renutrition coupled with oral renutrition; hospitalization far from the patient's home; absence of hospital care in psychiatry after medical stabilization in a somatic unit; compulsory hospitalization. Associated factors were: the presence of psychiatric comorbidities; greater weight gain during hospitalization. Among the factors related to a decrease in LOS, the clinical predictive factor were: greater self-confidence at admission (measured by the Eating Disorder Recovery Self-Efficacy Questionnaire). Therapeutic and management modality predictors included: increased caloric intake of oral renutrition on admission; intake of oral nutritional supplements on admission; and hospitalization in urban areas. The associated factor was: compliance with the weight contract in the adolescent population. DISCUSSION Factors related to an increase in LOS are explained by: higher resistance to treatment, higher severity of the disease, the time required for weight gain in services using cognitive-behavioural therapy, complications associated with renutrition modalities such as parenteral renutrition, difficulties in organising outpatient follow-up which require better consolidation of inpatient treatment and the lack of multidisciplinary care in medical services. Factors related to a decrease in LOS are due to: faster weight gain, the presence of a greater number of outpatient follow-up structures close to the hospital and better adherence to treatment to complete the weight contract. CONCLUSIONS Taking these factors into account during hospitalization for AN would help optimize care, duration and costs. This situation therefore requires the development of therapeutic trials targeting the identified factors in order to reduce LOS in the treatment of AN.
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Affiliation(s)
- R Lascar
- Faculté de médecine de Nice, UNS Santé, 28, avenue de Valombrose, 06107 Nice, France; Faculté de médecine, université Paris Sud XI, 63, rue Gabriel Péri, 94270 le Kremlin-Bicêtre, France.
| | - A Letranchant
- Département de psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - F Hirot
- Service hospitalo-universitaire de santé mentale de l'adolescent et du jeune adulte, Fondation Santé Des Étudiants de France, Paris, France; UFR Health Sciences Simone Veil, UVSQ, Saint-Quentin en Yvelynes, France; CESP, Inserm 1178, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
| | - N Godart
- Département de psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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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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Zanna V, Cinelli G, Criscuolo M, Caramadre AM, Castiglioni MC, Chianello I, Marchili MR, Casamento Tumeo C, Guolo S, Tozzi AE, Vicari S. Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study. Front Psychiatry 2021; 12:653482. [PMID: 34122177 PMCID: PMC8192691 DOI: 10.3389/fpsyt.2021.653482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP). Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11-18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups. Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs. Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.
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Affiliation(s)
- Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Chiara Casamento Tumeo
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
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Støving RK, Larsen PV, Winkler LA, Bilenberg N, Røder ME, Steinhausen H. Time trends in treatment modes of anorexia nervosa in a nationwide cohort with free and equal access to treatment. Int J Eat Disord 2020; 53:1952-1959. [PMID: 32893903 PMCID: PMC7754480 DOI: 10.1002/eat.23378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Treating patients with anorexia nervosa (AN) remains a major challenge. The choice between an inpatient or an outpatient care setting is an essential issue for the patients and for their relatives with major health economic implications. However, health services-related studies are lacking. The present study was a descriptive exploration of time-trends in treatment modes of patients with free and equal access to health services. METHODS The study was based on a nationwide cohort of patients diagnosed for the first time with AN, each followed for 5 years in the registers covering the years 1994-2018. The per patient number of hospital admissions, cumulated number of days of hospitalization and number of outpatient visits during the first 5 years after initial diagnosis were considered. RESULTS The cohort of patients with AN with at least 5 years of follow-up amounted to N = 7,505. A clear trend was observed in the per patient five-year cumulated number of inpatient days, decreasing by 6% per year after adjustment for age at diagnosis, parental mental diagnosis, and family income. The five-year number of hospital admissions after initial diagnosis decreased by 2% per year, while no trend was observed for outpatient visits. CONCLUSIONS The per patient number of hospitalizations and cumulated days of hospitalization during 5 years after diagnosis were reduced for patients initially diagnosed with AN while there was no change in the number of outpatient visits. The factors contributing to these changes of treatment modes over time are in need of further study.
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Affiliation(s)
- René Klinkby Støving
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Research Unit for Medical EndocrinologyOdense University HospitalOdenseDenmark,Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark,Open Patient data Explorative Network (OPEN)Clinical Institute, University of Southern DenmarkOdenseDenmark
| | - Pia Veldt Larsen
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | - Laura Al‐Dakhiel Winkler
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | | | - Hans‐Christoph Steinhausen
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark,Denmark Child and Adolescent Mental Health CentreCapital Region PsychiatryCopenhagenDenmark,Department of Child and Adolescent PsychiatryPsychiatric University Hospital of ZurichZurichSwitzerland,Clinical Psychology and EpidemiologyInstitute of Psychology, University of BaselBaselSwitzerland
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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: 25] [Impact Index Per Article: 6.3] [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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Dalle Grave R, Conti M, Calugi S. Effectiveness of intensive cognitive behavioral therapy in adolescents and adults with anorexia nervosa. Int J Eat Disord 2020; 53:1428-1438. [PMID: 32691431 DOI: 10.1002/eat.23337] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive behavioral therapy (CBT-E) in adolescent and adult patients with anorexia nervosa. METHODS A total of 150 consecutive patients (74 adolescents and 81 adults) were admitted to a 20-week intensive CBT-E program (13 weeks of inpatient followed by 7 weeks of day-hospital treatment). All patients had responded poorly to previous outpatient treatments and were assessed at admission, end of treatment (EOT), and 20- and 60-week follow-ups. RESULTS About 70% of eligible patients began the program, and more than 85% completed it. Body mass index (BMI) in adults and BMI-for-age percentile in adolescents improved significantly from baseline to EOT, remained stable until 20-week follow-up, and slightly decreased from 20-week follow-up to 60-week follow-up, while remaining in the lower normal range. Eating disorder psychopathology, general psychopathology, and clinical impairment scores decreased significantly at EOT and showed only a slight increase from EOT to follow-ups. No difference was found between adolescent and adult patients in treatment acceptance, dropout, or any outcome measure. DISCUSSION These findings indicate that intensive CBT-E seems to be an effective treatment for severely ill adolescent and adult patients with anorexia nervosa.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Veneto, Italy
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Byford S, Petkova H, Stuart R, Nicholls D, Simic M, Ford T, Macdonald G, Gowers S, Roberts S, Barrett B, Kelly J, Kelly G, Livingstone N, Joshi K, Smith H, Eisler I. Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.
Objectives
The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.
Design
Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.
Setting
Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.
Participants
A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.
Interventions
Community-based specialist eating disorders services and generic CAMHS.
Main outcome measures
Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.
Data sources
Data were collected by clinicians from clinical records.
Results
Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied.
Limitations
Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses.
Conclusions
The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers.
Future work
Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services.
Trial registration
Current Controlled Trials ISRCTN12676087.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dasha Nicholls
- Department of Medicine, Imperial College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Institute of Health Research, Department of Psychological Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Sarah Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Grace Kelly
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nuala Livingstone
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Kandarp Joshi
- Child and Adolescent Mental Health Service, Royal Cornhill Hospital, NHS Grampian, Aberdeen, UK
- Mental Health Division, University of Aberdeen, Aberdeen, UK
| | | | - Ivan Eisler
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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11
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Hay PJ, Touyz S, Claudino AM, Lujic S, Smith CA, Madden S. Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders. Cochrane Database Syst Rev 2019; 1:CD010827. [PMID: 30663033 PMCID: PMC6353082 DOI: 10.1002/14651858.cd010827.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clinical guidelines recommend outpatient care for the majority of people with an eating disorder. The optimal use of inpatient treatment or combination of inpatient and partial hospital care is disputed and practice varies widely. OBJECTIVES To assess the effects of treatment setting (inpatient, partial hospitalisation, or outpatient) on the reduction of symptoms and increase in remission rates in people with:1. Anorexia nervosa and atypical anorexia nervosa;2. Bulimia nervosa and other eating disorders. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 2 July 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 20 November 2015). We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (6 July 2018). We ran a forward citation search on the Web of Science to identify additional reports citing any of the included studies, and screened reference lists of included studies and relevant reviews identified during our searches. SELECTION CRITERIA We included randomised controlled trials that tested the efficacy of inpatient, outpatient, or partial hospital settings for treatment of eating disorder in adults, adolescents, and children, whose diagnoses were determined according to the DSM-5, or other internationally accepted diagnostic criteria. We excluded trials of treatment setting for medical or psychiatric complications or comorbidities (e.g. hypokalaemia, depression) of an eating disorder. DATA COLLECTION AND ANALYSIS We followed standard Cochrane procedures to select studies, extract and analyse data, and interpret and present results. We extracted data according to the DSM-5 criteria. We used the Cochrane tool to assess risk of bias. We used the mean (MD) or standardised mean difference (SMD) for continuous data outcomes, and the risk ratio (RR) for binary outcomes. We included the 95% confidence interval (CI) with each result. We presented the quality of the evidence and estimate of effect for weight or body mass index (BMI) and acceptability (number who completed treatment), in a 'Summary of findings' table for the comparison for which we had sufficient data to conduct a meta-analysis. MAIN RESULTS We included five trials in our review. Four trials included a total of 511 participants with anorexia nervosa, and one trial had 55 participants with bulimia nervosa. Three trials are awaiting classification, and may be included in future versions of this review. We assessed a risk of bias from lack of blinding of participants and therapists in all trials, and unclear risk for allocation concealment and randomisation in one study.We had planned four comparisons, and had data for meta-analyses for one. For anorexia nervosa, there may be little or no difference between specialist inpatient care and active outpatient or combined brief hospital and outpatient care in weight gain at 12 months after the start of treatment (standardised mean difference (SMD) -0.22, 95% CI -0.49 to 0.05; 2 trials, 232 participants; low-quality evidence). People may be more likely to complete treatment when randomised to outpatient care settings, but this finding is very uncertain (risk ratio (RR) 0.75, 95% CI 0.64 to 0.88; 3 trials, 319 participants; very low-quality evidence). We downgraded the quality of the evidence for these outcomes because of risks of bias, small numbers of participants and events, and variable level of specialist expertise and intensity of treatment.We had no data, or data from only one trial for the primary outcomes for each of the other three comparisons.No trials measured weight or acceptance of treatment for anorexia nervosa, when comparing inpatient care provided by a specialist eating disorder service and health professionals and a waiting list, no active treatment, or treatment as usual.There was no clear difference in weight gain between settings, and only slightly more acceptance for the partial hospital setting over specialist inpatient care for weight restoration in anorexia nervosa.There was no clear difference in weight gain or acceptability of treatment between specialist inpatient care and partial hospital care for bulimia nervosa, and other binge eating disorders. AUTHORS' CONCLUSIONS There was insufficient evidence to conclude whether any treatment setting was superior for treating people with moderately severe (or less) anorexia nervosa, or other eating disorders.More research is needed for all comparisons of inpatient care versus alternate care.
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Affiliation(s)
- Phillipa J Hay
- Western Sydney UniversityTranslational Health Research InstitutePenrithNew South WalesAustralia2751
- Western Sydney UniversitySchool of MedicineLocked Bag 1797Penrith South DCNSWAustralia2751
| | - Stephen Touyz
- University of SydneySchool of Psychology and Boden Institute School of MedicineSydneyNSWAustralia2006
| | - Angélica M Claudino
- Federal University of São Paulo (UNIFESP)Department of Psychiatry and Psychological MedicineRua Borges Lagoa 570 conj. 71São PauloSão PauloBrazil04038‐000
| | - Sanja Lujic
- UNSWCentre for Big Data Research in HealthCBDRH, Lowy Building, Level 4UNSW SydneyNSWAustralia2052
| | - Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Sloane Madden
- University of SydneyThe Children's Hospital at WestmeadSydneyAustralia
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12
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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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13
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Wallis A, Miskovic-Wheatley J, Madden S, Alford C, Rhodes P, Touyz S. Does continuing family-based treatment for adolescent anorexia nervosa improve outcomes in those not remitted after 20 sessions? Clin Child Psychol Psychiatry 2018; 23:592-600. [PMID: 29781302 DOI: 10.1177/1359104518775145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our aim was to investigate the benefit of ongoing family-based treatment (FBT) sessions for adolescent anorexia nervosa if remission criteria were not met at session 20. METHOD Participants were 69 medically unstable adolescents with Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) anorexia nervosa from a randomized controlled trial investigating length of hospital admission prior to outpatient FBT. Participants were divided post hoc into those meeting remission criteria at session 20 ( n = 16), those that had not remitted but continued with FBT ( n = 39) and those who ceased FBT undertaking alternative treatments ( n = 14). Outcome was assessed as remission and hospital readmission days at 12 months after FBT session 20. RESULTS There were no differences between groups at baseline. There was a significant difference in the use of hospital admission days with those in the Alternate Treatment Group who did not continue with FBT using 71.93 days compared to those in Additional FBT Group with only 12.51 days ( F(2, 66) = 13.239, p < .01). At 12 months after FBT session 20, the Additional FBT Group had a 28.2% increase in remission rate, significantly higher than those in the Alternate Treatment Group (χ2(2) = 17.68, p < .001). DISCUSSION Continuing FBT after session 20 if remission is not achieved can significantly reduce hospital readmission days and improve remission rates.
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Affiliation(s)
- Andrew Wallis
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia.,2 School of Psychology, The University of Sydney, Australia
| | | | - Sloane Madden
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Colleen Alford
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Paul Rhodes
- 2 School of Psychology, The University of Sydney, Australia
| | - Stephen Touyz
- 2 School of Psychology, The University of Sydney, Australia
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14
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Wallis A, Miskovic-Wheatley J, Madden S, Rhodes P, Crosby RD, Cao L, Touyz S. Family Functioning and Relationship Quality for Adolescents in Family-based Treatment with Severe Anorexia Nervosa Compared with Non-clinical Adolescents. EUROPEAN EATING DISORDERS REVIEW 2017; 26:29-37. [PMID: 29034536 DOI: 10.1002/erv.2562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/12/2022]
Abstract
This longitudinal study explored family functioning and relationship quality for adolescents with severe anorexia nervosa (AN). An important outcome given healthy family functioning supports effective adolescent development. Fifty-four female adolescents and their parents, treated with family-based treatment after inpatient admission, and 49 non-clinical age-matched adolescents and their parents were compared at assessment and 6 months after session 20. At baseline, AN group mothers and fathers reported poorer family function. AN adolescents were notably similar to controls, reporting poorer function in only one domain. There were no changes for adolescents, an improvement for mothers in the AN group, but an increase in perceived impairment for fathers in both groups, with AN fathers more affected. The similarity in adolescent reports and the increase for fathers over time may indicate that normal adolescent family processes occur even in the midst of serious illness. There is a need to provide intervention to ameliorate the impact of treatment on parents. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Andrew Wallis
- Eating Disorder Service, The Sydney Children's Hospital Network, Australia.,School of Psychology, The University of Sydney, Australia.,Department of Adolescent Medicine, The Sydney Children's Hospital Network, Australia
| | | | - Sloane Madden
- Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Paul Rhodes
- School of Psychology, The University of Sydney, Australia
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA.,School of Medicine and Health Sciences, University of North Dakota, Fargo, ND, USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Stephen Touyz
- School of Psychology, The University of Sydney, Australia
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15
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Kapphahn CJ, Graham DA, Woods ER, Hehn R, Mammel KA, Forman SF, Fisher M, Robinson KA, Rome ES, Hergenroeder A, Golden NH. Effect of Hospitalization on Percent Median Body Mass Index at One Year, in Underweight Youth With Restrictive Eating Disorders. J Adolesc Health 2017; 61:310-316. [PMID: 28587796 DOI: 10.1016/j.jadohealth.2017.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Data from low-weight patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED treatment programs were analyzed to determine whether there was an association between hospitalization and gain to at least 90% median body mass index (mBMI) at 1-year follow-up. METHODS Data were retrospectively collected for 322 low-weight (<85% mBMI at intake) patients aged 9-21 years, who presented with restrictive EDs to 14 adolescent medicine-based ED programs in 2010. Positive outcome was defined as being at least 90% mBMI (%mBMI = patient's body mass index/mBMI for age × 100) at 1-year follow-up. Association between treatment at a higher level of care and gain to at least 90% mBMI was analyzed for 140 patients who were <85% mBMI at the time of presentation, had not been previously hospitalized, and had 1-year follow-up data available. RESULTS For patients presenting at <85% mBMI, those who were hospitalized in the year following intake had 4.0 (95% confidence interval: 1.6-10.1) times the odds of gain to at least 90% mBMI, compared with patients who were not hospitalized, when controlling for baseline %mBMI. CONCLUSION In this national cohort of patients with restrictive EDs presenting to adolescent medicine-based ED programs at <85% mBMI, those who were hospitalized had greater odds of being at least 90% mBMI at 1-year follow-up.
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Affiliation(s)
- Cynthia J Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
| | - Dionne A Graham
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Hehn
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Kathleen A Mammel
- Division of Adolescent Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; Formerly of Department of Adolescent Pediatrics, Beaumont Children's Hospital, Royal Oak, Michigan
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York; Department of Pediatrics, Hofstra-Northwell Health School of Medicine, Hempstead, New York
| | - Kelly A Robinson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Ellen S Rome
- Department of General Pediatrics, Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Albert Hergenroeder
- Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Neville H Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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16
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Schmidt U, Sharpe H, Bartholdy S, Bonin EM, Davies H, Easter A, Goddard E, Hibbs R, House J, Keyes A, Knightsmith P, Koskina A, Magill N, McClelland J, Micali N, Raenker S, Renwick B, Rhind C, Simic M, Sternheim L, Woerwag-Mehta S, Beecham J, Campbell IC, Eisler I, Landau S, Ringwood S, Startup H, Tchanturia K, Treasure J. Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen Sharpe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Savani Bartholdy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Helen Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Abigail Easter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Elizabeth Goddard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer House
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandra Keyes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Pooky Knightsmith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Antonia Koskina
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicholas Magill
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica McClelland
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nadia Micali
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bethany Renwick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Rhind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lot Sternheim
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Woerwag-Mehta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Iain C Campbell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Helen Startup
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Chiesa M, Cirasola A, Fonagy P. Four years comparative follow-up evaluation of community-based, step-down, and residential specialist psychodynamic programmes for personality disorders. Clin Psychol Psychother 2017; 24:1331-1342. [PMID: 28748608 DOI: 10.1002/cpp.2109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/12/2022]
Abstract
Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital-based to psychodynamically- and cognitively-oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high-intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4-year period in 3 groups of patients with personality disorders (N = 162) treated in a specialist community-based (CBP, N = 30), a step-down (RT-CBP, N = 87), and a specialist residential programme (RT, N = 45) in psychiatric distress, deliberate self-injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early-dropout were significantly different (p = .0001) for the 3 programmes (CBP = 13.4%, RT-CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p = .001), with CBP and RT-CBP achieving more marked changes (g = 1.20 and g = 0.68, respectively) compared to RT (g = 0.30) at 48-month follow-up. CBP and RT-CBP were found to significantly reduce impulsive behaviour (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long-term RT showed no advantage over long-term CBP, either as stand-alone or as step-down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results.
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Affiliation(s)
- Marco Chiesa
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Formerly Consultant Psychiatrist, The Cassel Hospital, Richmond, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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18
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Piazza A, Rucci P, Clo M, Gibertoni D, Camellini L, Di Stani M, Fantini MP, Ferri M, Fioritti A. Health services utilization in patients with eating disorders: evidence from a cohort study in Emilia-Romagna. Eat Weight Disord 2016; 21:625-633. [PMID: 27682243 DOI: 10.1007/s40519-016-0323-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To estimate the treated prevalence of eating disorders (ED) in Emilia-Romagna, Italy, and to compare health services utilization among age groups and geographical areas. METHODS The study cohort consists of patients aged 12-64 years with a primary or secondary ED diagnosis, treated in regional healthcare facilities in 2012. Patients were followed up for 1 year from the first contact. Data were extracted from regional administrative databases. RESULTS The study cohort included 1550 cases, 36.8 % with anorexia nervosa, 21.9 % with bulimia nervosa and 41.3 % with ED not otherwise specified. Adolescents (12-17 years) were 18.6 %, young adults (18-30) 32.7 % and older adults (31-64) 48.7 %. The annual treated prevalence rate was 5.2/10,000 (13.3 for adolescents, 9.3 for young adults and 3.4 for older adults) and was highest among adolescent (24.6/10,000) and young adult females (17.1/10,000). Cases without a record for ED in the previous year were 46.8 %. Older adults displayed higher comorbidity and used more services including hospital-based care. Outpatient care greatly exceeded inpatient care across age groups. Variations in care patterns across regional areas were found. CONCLUSIONS Our results indicate that the care pathway for ED varies among age groups and geographical areas, but is consistent with the regional care model that favors the use of outpatient services. Future perspectives include evaluating the integration among mental health services, specialty outpatient units and primary care.
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Affiliation(s)
- Antonella Piazza
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Massimo Clo
- Information System Unit, Health Care and Social Authority, Emilia-Romagna Region, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Lucia Camellini
- Innovation and Organizational Evaluation Service, Modena Local Health Authority, Modena, Italy
| | - Marinella Di Stani
- Department of Mental Health and Pathological Addictions, Romagna Local Health Authority, Ravenna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Mila Ferri
- Outpatient Care Unit, Health Care and Social Authority, Emilia-Romagna Region, Bologna, Italy
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19
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Pratt HD, Phillips EL, Greydanus DE, Patel DR. Eating Disorders in the Adolescent Population:. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558403018003007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents become vulnerable to developing eating disorders as they mature. Very little is known about the prevalence, etiology, assessment, treatment, and outcome of eating disorders among adolescents. In general, research on eating disorders continues to be plagued with design flaws. Future studies need to be prospective research based on larger, more diverse samples of adolescents that represent all developmental stages of adolescence. Consistent diagnostic criteria and definitions of treatment interventions and outcomes also need to be employed. In addition, research should address the identification of protective and risk factors that predict who will actually develop an eating disorder.
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20
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Kezelman S, Rhodes P, Hunt C, Anderson G, Clarke S, Crosby RD, Touyz S. Adolescent patients’ perspectives on rapid-refeeding: a prospective qualitative study of an inpatient population. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21662630.2016.1202124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Barbot B, Bick J, Bentley MJ, Balestracci KM, Woolston JL, Adnopoz JA, Grigorenko EL. Changes in mental health outcomes with the intensive in-home child and adolescent psychiatric service: a multi-informant, latent consensus approach. Int J Methods Psychiatr Res 2016; 25:33-43. [PMID: 26173903 PMCID: PMC6877220 DOI: 10.1002/mpr.1477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/18/2015] [Indexed: 11/10/2022] Open
Abstract
This study investigates the Intensive In-home Child and Adolescent Psychiatric Service (IICAPS), a large-scale home-based intervention that collaboratively engages the family, school, and various other service providers (e.g. health practitioners or judicial systems) to prevent the hospitalization, institutionalization or out-of-home placement of children and adolescents with serious emotional disturbance. Multi-informant data (youth, parents and clinician) on the level of youth problem severity and functioning was gathered from 7169 youth and their families served by the IICAPS network, pre- and post-intervention. A newly developed "Multi-informant Latent Consensus" (MILC) approach was employed to measure mental health "baseline levels" and change, within a Structural Equation Modeling framework. The MILC approach demonstrated promise integrating information from multiple informants involved in the therapeutic process to yield a more accurate and systemic view of a child's level of functioning and problem severity than each report taken individually. Results indicated that the IICAPS family and community based intervention model led to a reduction of problem severity and improved functioning in children and adolescents with severe emotional disturbance.
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Affiliation(s)
- Baptiste Barbot
- Department of PsychologyPace UniversityNew YorkUSA
- Child Study CenterYale UniversityNew HavenCTUSA
| | - Johanna Bick
- Boston Children's Hospital/Harvard Medical SchoolBostonMAUSA
| | | | | | | | | | - Elena L. Grigorenko
- Child Study CenterYale UniversityNew HavenCTUSA
- Moscow State University of Psychology and EducationMoscowRussia
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22
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Rosling A, Salonen Ros H, Swenne I. One-year outcome and incidence of anorexia nervosa and restrictive eating disorders among adolescent girls treated as out-patients in a family-based setting. Ups J Med Sci 2016; 121:50-9. [PMID: 26915921 PMCID: PMC4812058 DOI: 10.3109/03009734.2016.1141810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims To study the 1-year outcome and to analyse predictors of outcome of a cohort of adolescent girls with anorexia nervosa (AN) or restrictive eating disorders not otherwise specified (EDNOSr) treated as out-patients in a family-based programme at a specialized eating disorder service. To calculate the incidence of anorexia nervosa among treatment-seeking girls younger than 18 in Uppsala County from 2004 to 2006. Methods A total of 168 female patients were offered treatment, and 141 were followed-up 1 year after starting treatment, 29 with AN and 112 with EDNOSr. Results Of the 29 girls who initially had AN, 6 (20%) had a good outcome and were free of any form of eating disorder at follow-up; only 1 (3%) had AN. Of the patients with EDNOSr, 54 (48%) had a good outcome and were free of eating disorders. Three (3%) had a poor outcome and had developed AN. The incidence of AN was 18/100,000 person-years in girls younger than 12 and 63/100,000 in girls younger than 18. Conclusion Restrictive eating disorders, including AN, in children and adolescents can be successfully treated in a family-based specialized out-patient service without in-patient care.
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Affiliation(s)
- Agneta Rosling
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala, Sweden
- CONTACT Agneta Rosling, MD Department of Child and Adolescent Psychiatry, Uppsala University Hospital, S-751 85 Uppsala, Sweden
| | - Helena Salonen Ros
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Ingemar Swenne
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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23
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Fogarty S, Ramjan LM. Factors impacting treatment and recovery in Anorexia Nervosa: qualitative findings from an online questionnaire. J Eat Disord 2016; 4:18. [PMID: 27195122 PMCID: PMC4870791 DOI: 10.1186/s40337-016-0107-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by restriction of energy intake, fear of gaining weight and severe disturbances in weight or shape. Recovery from AN is a complicated and often multifaceted experience that can take many years to achieve. Qualitative research has found that support, being understood, hope, desire for recovery, positive experiences in treatment, self-efficacy, motivation and relationships are important in recovery from AN. The experience of treatment for patients with an eating disorder is an important aspect of recovery with the potential to enhance recovery or hinder it. The aim of the questionnaire was to better understand factors impacting the care experiences during treatment and or recovery from self-reported Anorexia Nervosa (AN). METHOD An online questionnaire was developed and administered to past or current sufferers of Anorexia Nervosa, ≥18 years of age. Participants were recruited through eating disorder organisations both in Australia and the United Kingdom. The questionnaire was a mixture of quantitative and qualitative questions. The quantitative data was analysed using descriptive statistics and the qualitative data was analysed using conventional content analysis (CCA). RESULTS Of those who responded, most currently experienced self-reported AN. The quantitative results identified that most participants had trust and confidence in their health care provider and felt listened to and supported yet on the subject of the suitability of treatment this had varied opinions. Being understood, hope (life after AN) and self-acceptance were considered the top three important factors in the treatment and recovery from Anorexia Nervosa. The qualitative results revealed the factors hindering or benefiting treatment and recovery, and individuals' needs during the four phases of recovery. CONCLUSION Factors were identified that could either hinder or benefit treatment and recovery and these included whether treatment supported the individual to cope with change, whether the individual found the treatment to be appropriate for their personal needs and whether treatment addressed underlying factors. Individuals' needs differed during the four phases of recovery. The findings of the study may help treatment providers address key factors involved in recovery at the right stage of treatment however by the nature of the qualitative methodology conclusions are putative and further definitive research is indicated.
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Affiliation(s)
- Sarah Fogarty
- School of Medicine, Western Sydney University, Richmond, Australia ; National Institute of Complementary Medicine, Western Sydney University, PO Box 2002, Homebush West, NSW 2140 Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Richmond, Australia ; Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, Richmond, Australia
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24
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Schlegl S, Diedrich A, Neumayr C, Fumi M, Naab S, Voderholzer U. Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome. EUROPEAN EATING DISORDERS REVIEW 2015; 24:214-22. [PMID: 26603278 DOI: 10.1002/erv.2416] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/27/2015] [Accepted: 10/22/2015] [Indexed: 11/06/2022]
Abstract
This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Alice Diedrich
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | | | | | | | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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25
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Rance N, Moller NP, Clarke V. ‘Eating disorders are not about food, they’re about life’: Client perspectives on anorexia nervosa treatment. J Health Psychol 2015; 22:582-594. [PMID: 26446375 DOI: 10.1177/1359105315609088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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26
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Hillen S, Dempfle A, Seitz J, Herpertz-Dahlmann B, Bühren K. Motivation to change and perceptions of the admission process with respect to outcome in adolescent anorexia nervosa. BMC Psychiatry 2015; 15:140. [PMID: 26134628 PMCID: PMC4488048 DOI: 10.1186/s12888-015-0516-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), there is evidence that readiness to change is an important predictor of outcome with respect to weight gain and improvement in eating disorder psychopathology. In particular, young patients are characterized by a low level of motivation for recovery and perceive more coercion at hospitalization. Thus, a better understanding of the variables that influence readiness to change and perception of the admission process in adolescent AN may help to support patients in initiating change and staying motivated for treatment. METHODS In 40 adolescent patients diagnosed with AN according to DSM-IV criteria, we assessed in a prospective clinical cohort study the motivation to change using the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) at admission to inpatient treatment, in week 9 after admission and at discharge. Additional variables were assessed, including depressive symptoms (Beck Depression Inventory, BDI), eating disorder-specific psychopathology (Eating Disorder Inventory, EDI-2), body mass index (BMI) and the percentage of expected body weight (%EBW). The patients' perceptions of the admission process and their perceived need for hospitalization were assessed using a self-report scale developed by Guarda et al. (2007). RESULTS Younger patients perceived more coercion than older patients did. Low %EBW and more severe eating disorder-specific psychopathology were associated with a greater perceived need for hospitalization. Moreover, low %EBW at admission and a longer duration of illness were accompanied by a greater motivation to change at admission, whereas more severe eating disorder psychopathology was associated with a low motivation to change. The motivation to change increased significantly between admission and discharge. Patients with a greater motivation to change at admission exhibited a higher weekly weight gain during treatment but did not show better outcome in eating disorder-specific psychopathology and depression. CONCLUSIONS Motivation to change is an important predictor of short-term outcome with respect to weight gain trajectory during treatment of adolescent AN. As patients with a higher BMI at admission and those with more severe eating disorder-specific symptoms seem to be less motivated to change, the crucial issue of motivation to change should be addressed with these patients during the therapeutic process.
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Affiliation(s)
- Simona Hillen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Astrid Dempfle
- Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany.
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany.
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
| | - Katharina Bühren
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Germany.
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Seed T, Fox J, Berry K. Experiences of Detention under the Mental Health Act for Adults with Anorexia Nervosa. Clin Psychol Psychother 2015; 23:352-62. [PMID: 26123878 DOI: 10.1002/cpp.1963] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022]
Abstract
UNLABELLED People with Anorexia Nervosa are often resistant to treatment and can be detained under the Mental Health Act. Detention can be distressing for some client groups; however, there is little research to explore how people with Anorexia Nervosa experience detention and how these experiences impact on recovery. This study utilized a qualitative methodology to develop a model for understanding how people perceive, experience and process detention under the Mental Health Act. Data from 12 participants was analysed using constructivist grounded theory. Four overarching categories conceptualize their experience over time: 'the battle', 'the bubble', 'stepping out of the bubble' and 'the anorexic self'. Within each overarching category are further subordinate categories that represent the nuances of the data. The resultant model is discussed in relation to the literature, whilst recommendations have been made to embed person-centred, recovery practice into inpatient services. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE People detained under the mental health act with anorexia nervosa often respond by engaging in a battle with clinicians. This follows by the person withdrawing into a 'bubble' where the individual starts to feel some relief that they are no longer in control of their eating, but this competes with the lack of self and the emerging anorexic self. Clinicians need to be aware that individuals detained may have mixed feelings about their hospital admission.
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Affiliation(s)
- Tara Seed
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - John Fox
- Department of Psychology, Royal Holloway University of London, Egham, UK
- Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust
| | - Katherine Berry
- School of Psychological Sciences, The University of Manchester, Manchester, UK
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28
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Legenbauer TM, Meule A. Challenges in the Treatment of Adolescent Anorexia Nervosa - Is Enhanced Cognitive Behavior Therapy The Answer? Front Psychiatry 2015; 6:148. [PMID: 26528192 PMCID: PMC4604253 DOI: 10.3389/fpsyt.2015.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/02/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tanja M Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum , Hamm , Germany
| | - Adrian Meule
- Department of Psychology, Center for Cognitive Neuroscience, University of Salzburg , Salzburg , Austria
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29
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Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med 2015; 45:415-427. [PMID: 25017941 PMCID: PMC4301212 DOI: 10.1017/s0033291714001573] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN. METHOD We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT). RESULTS The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group. CONCLUSIONS Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
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Affiliation(s)
- S. Madden
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
| | - J. Miskovic-Wheatley
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Westmead Clinical School, The University of Sydney, Australia
| | - A. Wallis
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
| | - M. Kohn
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - J. Lock
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - D. Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - B. Jo
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - S. Clarke
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - P. Rhodes
- School of Psychology, The University of Sydney, Australia
| | - P. Hay
- Centre for Health Research, School of Medicine, The University of Western Sydney and School of Medicine, James Cook University, Australia
| | - S. Touyz
- School of Psychology, The University of Sydney, Australia
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30
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Adlam J. Refusal and coercion in the treatment of severe Anorexia Nervosa: The Antigone paradigm. PSYCHODYNAMIC PRACTICE 2014. [DOI: 10.1080/14753634.2014.989714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Fenner M, Kleve L. An evaluation of a CAMHS outpatient service for adolescent eating disorders. Child Adolesc Ment Health 2014; 19:64-68. [PMID: 32878367 DOI: 10.1111/camh.12014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND A CAMHS Eating Disorder (ED) service is presented together with cases referred and treated within a 3-year period. An outcome evaluation was conducted for restrictive eating disorders. METHOD Case files were analysed to investigate service throughput as well as clinical outcomes for discharged cases (n = 39). RESULTS Highly positive End of Treatment (EOT) outcomes were achieved for both anorexia nervosa (AN) and Eating Disorders Not Otherwise Specified (EDNOS). Morgan Russell scores, drop-out and admission rates compared favourably with previous trials. User satisfaction ratings were high. CONCLUSION The study offers insight into real-life clinical practice and as outpatient treatment is usually much less expensive than inpatient treatment, this approach has the potential to be cost-effective.
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Affiliation(s)
- Mary Fenner
- Psychology Solutions Partnership, PO BOX 2744, Bristol, BS6 9EA, UK.,North Somerset Specialist Children's services, Community CAMHS and LD, Drove Rd, Weston Super Mare, North Somerset, BS23 3NT, UK
| | - Liv Kleve
- North Somerset Specialist Children's services, Community CAMHS and LD, Drove Rd, Weston Super Mare, North Somerset, BS23 3NT, UK
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Kermarrec S, Kabuth B, Rat AC, Vidailhet M, Vidailhet C. The Outcome of Adolescent-Onset Anorexia Nervosa: A Study of 144 Cases. Health (London) 2014. [DOI: 10.4236/health.2014.614221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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33
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Bezance J, Holliday J. Mothers' experiences of home treatment for adolescents with anorexia nervosa: an interpretative phenomenological analysis. Eat Disord 2014; 22:386-404. [PMID: 25024015 DOI: 10.1080/10640266.2014.925760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Home treatment (HT) is emerging as an alternative to admission for adolescents with anorexia nervosa. It relies heavily on parental (often maternal) input to be effective. Given the high levels of carer stress reported by mothers, the current study aimed to explore mothers' experience of HT. A qualitative study using purposeful sampling was conducted. Nine interviews were analyzed using interpretative phenomenological analysis. Two contextual themes described the mother-daughter relationship and maternal stress and distress prior to HT. The third theme, "experience of help," included sub-themes of when help is needed, the need for containment, gaining strength and skills, and how HT met families' philosophy and values. The results support previous research on the stress that mothers particularly are under when their adolescent daughters have anorexia nervosa, and provides rich data on their experiences. HT is perceived as having both helpful and unhelpful aspects. Further research on its effectiveness is needed.
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Affiliation(s)
- Jessica Bezance
- a Oxford Institute of Clinical Psychology Training, Isis Education Centre, Warneford Hospital , Headington , Oxford , UK
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Dalle Grave R, Calugi S, El Ghoch M, Conti M, Fairburn CG. Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: immediate and longer-term effects. Front Psychiatry 2014; 5:14. [PMID: 24575055 PMCID: PMC3921605 DOI: 10.3389/fpsyt.2014.00014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. METHOD Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12 months later. RESULTS Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. CONCLUSION These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa.
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Affiliation(s)
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital , Garda , Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital , Garda , Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital , Garda , Italy
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Morris J, Simpson AV, Voy SJ. Length of Stay of Inpatients with Eating Disorders. Clin Psychol Psychother 2013; 22:45-53. [DOI: 10.1002/cpp.1865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 11/05/2022]
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Bourion-Bedes S, Baumann C, Kermarrec S, Ligier F, Feillet F, Bonnemains C, Guillemin F, Kabuth B. Prognostic value of early therapeutic alliance in weight recovery: a prospective cohort of 108 adolescents with anorexia nervosa. J Adolesc Health 2013; 52:344-50. [PMID: 23299014 DOI: 10.1016/j.jadohealth.2012.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/23/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine whether patients' perception of early therapeutic alliance (TA) could predict time to achieve a target weight among adolescents undergoing treatment for anorexia nervosa. METHOD TA was assessed in a prospective cohort recruited from both inpatient and outpatient settings by self-administered and validated questionnaires. Kaplan-Meier survival curves were compared by log rank test, and Cox regression was used to test whether patients' perception of early TA predicted time to achieve a target weight. RESULTS In total, 108 patients were included, and 79.6% achieved a target weight. Better patient perception of early TA increased the hazard ratio (HR) of achieving a target weight (HR = 2.7, 95% confidence interval: 1.7-4.4, p < .001) such as being in the inpatient setting by 6.7. Being very severely underweight at admission decreased the HR of achieving the target weight. CONCLUSION Patients' perception of early TA is a good predictor of achieving a target weight. Because TA is a modifiable construct, it could be a target for intervention.
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House J, Schmidt U, Craig M, Landau S, Simic M, Nicholls D, Hugo P, Berelowitz M, Eisler I. Comparison of specialist and nonspecialist care pathways for adolescents with anorexia nervosa and related eating disorders. Int J Eat Disord 2012; 45:949-56. [PMID: 23034735 DOI: 10.1002/eat.22065] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To explore the role of specialist outpatient eating disorders services and investigate how direct access to these affects rates of referral, admissions for inpatient treatment, and continuity of care. METHOD Services beyond primary care in Greater London retrospectively identified adolescents who presented with an eating disorder over a 2-year period. Data concerning service use were collected from clinical casenotes. RESULTS In areas where specialist outpatient services were available, 2-3 times more cases were identified than in areas without such services. Where initial outpatient treatment was in specialist rather than nonspecialist services, there was a significantly lower rate of admission for inpatient treatment and considerably higher consistency of care. DISCUSSION Developing specialist outpatient services with direct access from primary care is likely to lead to improvements in treatment and reduce overall costs.
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Affiliation(s)
- Jennifer House
- Department of Psychology, Section of Family Therapy, Institute of Psychiatry, King's College London, London, United Kingdom
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Carter N, Webb C, Findlay S, Grant C, Blyderveen SV. The integration of a specialized eating disorders nurse on a general inpatient pediatric unit. J Pediatr Nurs 2012; 27:549-56. [PMID: 22920665 DOI: 10.1016/j.pedn.2011.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 06/21/2011] [Accepted: 06/25/2011] [Indexed: 11/25/2022]
Abstract
Eating disorders (EDs) affect approximately 5% of Canadian adolescents. Patients experiencing acute medical complications of their illness are often treated on a general pediatric ward with mixed populations. Twenty-one health care providers shared their experiences caring for youth with EDs and provided feedback regarding the integration of a specialized ED nurse (ED-RN). Findings suggest that an RN and ED-RN model produces consistent care for ED patients and satisfying therapeutic relationships for nurses. ED-RNs caring for youth with EDs need support from their peers, whereas other nurses need training regarding this population. Suggestions for the integration of specialized RN roles are discussed.
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Affiliation(s)
- Nancy Carter
- School of Nursing, McMaster University, Hamilton, ON, Canada.
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Ornstein RM, Lane-Loney SE, Hollenbeak CS. Clinical outcomes of a novel, family-centered partial hospitalization program for young patients with eating disorders. Eat Weight Disord 2012; 17:e170-7. [PMID: 23086252 DOI: 10.1007/bf03325344] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM Eating disorders (ED) in children and younger adolescents are becoming more evident, but there is a small evidence base for their management in this population. We hypothesized that a new family-centered partial hospital program for young patients would be effective in promoting weight gain, as well as improvement in psychiatric symptoms. METHODS A retrospective chart review of 56 patients treated in the program between August 2008 and November 2009 was performed. Historical data, anthropometric variables and scores from psychological instruments [Children's Eating Attitudes Test (ChEAT), Children's Depression Inventory (CDI), and Revised Children's Manifest Anxiety Scale (RCMAS)] were collected on admission and at discharge. After exclusion, 30 patients were available for statistical analysis, using paired t-tests. The primary outcome variables were improvement in weight and change in total ChEAT score. Secondary outcomes included improvements in the CDI and RCMAS scores. Multivariate analysis included linear regression models that controlled for patient-specific fixed effects. RESULTS The cohort was 87% female with a mean age of 12.8±2 years; 60% were diagnosed with ED not otherwise specified. Two-thirds had a co-morbid depressive and/or anxiety disorder. Change in weight was significant (p<0.0001), as were improvements on total ChEAT (p<0.0001), CDI (p=0.0002), and RCMAS (p<0.0001) scores. No historical factors were correlated with improvement, nor was use of psychotropic medications. Length of stay in weeks significantly predicted greater weight gain (p=0.004, R2=0.26). CONCLUSIONS Patients treated in a family-centered partial hospital program had significant improvements in weight and psychological parameters. This approach holds significant promise for the management of young ED patients.
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Affiliation(s)
- R M Ornstein
- Department of Pediatrics, Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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Park RJ, Dunn BD, Barnard PJ. Schematic Models and Modes of Mind in Anorexia Nervosa II: Implications for Treatment and Course. Int J Cogn Ther 2012. [DOI: 10.1521/ijct.2012.5.1.86] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Godart N, Berthoz S, Curt F, Perdereau F, Rein Z, Wallier J, Horreard AS, Kaganski I, Lucet R, Atger F, Corcos M, Fermanian J, Falissard B, Flament M, Eisler I, Jeammet P. A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PLoS One 2012; 7:e28249. [PMID: 22238574 PMCID: PMC3251571 DOI: 10.1371/journal.pone.0028249] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 11/04/2011] [Indexed: 11/18/2022] Open
Abstract
Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated. Objective To compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT). Method Sixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization. Results At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10th percentile) and menstrual status. Conclusions Adding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN. Trial Registration Controlled-trials.com ISRCTN71142875
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Affiliation(s)
- Nathalie Godart
- Department of Adolescents and Young Adults Psychiatry, Institut Mutualiste Montsouris, Paris, France.
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Winston AP, Paul M, Juanola-Borrat Y. The same but different? Treatment of anorexia nervosa in adolescents and adults. EUROPEAN EATING DISORDERS REVIEW 2011; 20:89-93. [PMID: 21913286 DOI: 10.1002/erv.1137] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 05/12/2011] [Indexed: 11/11/2022]
Abstract
A significant number of patients with anorexia nervosa have to be transferred from child and adolescent mental health services (CAMHS) to adult services. CAMHS and adult services differ in terms of therapeutic approach and the availability of specialist treatment. CAMHS treatment is often based around family interventions, which aim to help parents take control of their child's eating, and patients are often encouraged to 'externalise' the illness. Adult treatment tends to be based around individual therapy, and the patient is encouraged to take personal responsibility for change. The place of inpatient treatment is generally accepted for adults but there is uncertainty about its effectiveness for adolescents. Young people may find it difficult to negotiate the transition between services, and CAMHS and adult services need to work more closely together. Transitions should be carefully planned, with thorough preparation of both patients and their families.
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Affiliation(s)
- Anthony P Winston
- Eating Disorders Unit, Woodleigh Beeches Centre, Coventry and Warwickshire Partnership Trust, Warwick, UK.
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Rigaud D, Pennacchio H, Bizeul C, Reveillard V, Vergès B. Outcome in AN adult patients: A 13-year follow-up in 484 patients. DIABETES & METABOLISM 2011; 37:305-11. [DOI: 10.1016/j.diabet.2010.11.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
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Ross JA, Green C. Inside the experience of anorexia nervosa: A narrative thematic analysis. COUNSELLING & PSYCHOTHERAPY RESEARCH 2011. [DOI: 10.1080/14733145.2010.486864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Treasure J, Crane A, McKnight R, Buchanan E, Wolfe M. First do no harm: Iatrogenic Maintaining Factors in Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2011; 19:296-302. [DOI: 10.1002/erv.1056] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Cognitive Remediation Therapy (CRT) was designed to address the inflexible and detail focused thinking styles frequently reported in individuals with Anorexia Nervosa (AN). This paper reports the development and acceptability of a pilot of CRT for AN in group format. Four group sessions were designed and piloted with 30 patients in an eating disorder service. The voluntary drop out rate was 20%. Outcome measures targeting patients' self-reported cognitive flexibility, self esteem and motivation to change were completed in the first and last sessions. Statistically significant gains were found in self reported ability to change (p=0.03). Both patients and group facilitators found the group acceptable, useful and a positive experience.
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Wallier J, Vibert S, Berthoz S, Huas C, Hubert T, Godart N. Dropout from inpatient treatment for anorexia nervosa: critical review of the literature. Int J Eat Disord 2009; 42:636-47. [PMID: 19208386 DOI: 10.1002/eat.20609] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High dropout rates from inpatient treatment for Anorexia Nervosa (AN) pose a serious obstacle to successful treatment. Because dropping out of inpatient treatment may have a negative impact on outcome, it is important to understand why dropout occurs so that treatment can be targeted toward keeping patients in care. We therefore conducted a critical literature review of studies on dropout from inpatient treatment for AN. METHOD Searches of Medline and PsycINFO revealed nine articles on this subject. Two were excluded because they did not differentiate AN from other eating disorders in analyses. RESULTS Results were scarce and conflicting, with methodological issues complicating comparisons. Weight on admission, AN subtype, eating disorder symptoms, greater psychiatric difficulty in general, and the absence of depression were related to dropout in multivariate analyses. DISCUSSION Authors should use a common definition of dropout and continue research on the identified predictors as well as potential predictors such as impulsivity and family factors.
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Affiliation(s)
- Jenny Wallier
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
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Currin L, Schmidt U. A critical analysis of the utility of an early intervention approach in the eating disorders. J Ment Health 2009. [DOI: 10.1080/09638230500347939] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am 2009; 18:131-45. [PMID: 19014862 DOI: 10.1016/j.chc.2008.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Departments of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
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