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Li Z, Hutchings-Hay C, Byford S, Tchanturia K. A qualitative evaluation of the pathway for eating disorders and autism developed from clinical experience (PEACE): clinicians' perspective. Front Psychiatry 2024; 15:1332441. [PMID: 38638414 PMCID: PMC11024361 DOI: 10.3389/fpsyt.2024.1332441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE pathway) is a clinical pathway of adapted treatment for individuals with eating disorders and autism in the UK. This study aims to investigate multidisciplinary clinicians' views of the strengths and challenges of PEACE pathway adaptations, while identifying areas where further improvement is needed. Method Semi-structured interviews were conducted with 16 clinicians who worked on the PEACE pathway. Themes relevant to the benefits, challenges and areas of improvement were identified, and a thematic map was produced. Results PEACE Pathway brought clinical benefits such as improved understanding of patients' perspective, improved flexibility and individualisation in clinicians' approach, increased patient engagement, and provision of resources that are helpful to all patients with or without autism. Benefits to the service included increase in autism awareness, clinicians' confidence, and team collaboration. Challenges were also identified, including difficulties in incorporating autism adaptations into existing treatment protocol, implementing PEACE at different levels of care, staff schedule conflicts, and increased pressure to meet patients' needs. Overall, there is a need for systemic improvement in aftercare and community support for autism, more suitable autism screening tool, and more structured guidelines for making adaptations. Conclusions and implications PEACE Pathway has brought clinical and service benefits, while also bringing practical challenges rooted in the difficulty in distinguishing between autism and eating disorder in comorbid population. Future areas of improvement are highlighted for PEACE resources as well as in the national support system for autistic individuals.
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Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Chloe Hutchings-Hay
- National Eating Disorders Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sarah Byford
- King’s Health Economics, Department of Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- National Eating Disorders Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Tbilisi State Medical University, Psychological Set Research and Correction Center, Tbilisi, Georgia
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Chubinidze D, Li Z, Slovak P, Baudinet J, Dufour E, Tchanturia K. Introducing a Smart Toy in Eating Disorder Treatment: A Pilot Study. Nutrients 2024; 16:467. [PMID: 38398792 PMCID: PMC10891985 DOI: 10.3390/nu16040467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Individuals with eating disorders (EDs) often encounter challenges related to body image, emotional, and sensory difficulties during nutritional rehabilitation. To address these challenges, a novel technology-enabled smart toy, Purrble, designed for immediate assistance in emotion regulation, is being explored. A mixed-method approach involving workshops, diaries, and focus groups was employed to examine the feasibility of Purrble as a therapeutic tool and its impact on participants' daily routines, sensory experiences, and emotional states. The study results demonstrate the engagement and acceptability of this device. Qualitative analysis revealed that participants independently used and integrated Purrble into their emotional and sensory regulation practices. These pilot results support the potential for a shift in the delivery of adjunct therapeutic tools through technology, particularly for ED patients with complex presentations. Future research is necessary to further explore the psychological benefits of this intervention.
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Affiliation(s)
- Dimitri Chubinidze
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
| | - Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
| | - Petr Slovak
- Department of Informatics, King’s College London, London WC2B 4BG, UK;
| | - Julian Baudinet
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, London SE5 8AZ, UK
| | - Emmanuelle Dufour
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (D.C.); (Z.L.); (J.B.)
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK;
- Department of Psychology, Ilia State University, Tbilisi 0162, Georgia
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Halls D, Batchelor R, Holetic V, Leppanen J, Williams S, Tchanturia K. Longitudinal exploration of biopsychosocial profiles in individuals with anorexia nervosa. J Psychiatr Res 2023; 167:16-22. [PMID: 37806284 DOI: 10.1016/j.jpsychires.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/14/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Previous work in individuals with Anorexia Nervosa (AN) has demonstrated a range of psycho-social difficulties such as increased anxiety, depression, obsessive-compulsive symptoms, as well as difficulties in work and with interpersonal interactions. However, making inferences regarding the stability of these psycho-social difficulties from previous studies is challenging, due to lack of a control group and known frequentist statistical issues. METHODS 134 participants, 40 healthy controls (HC) and 94 participants with AN, completed self-reported measures designed to explore eating disorder concerns, body mass index, mood symptoms, work and social functioning as well as traits associated with autism at two time points, two years apart. A principal component analysis and Bayesian mixed effects models were used to build and explore group differences in bio-psychosocial profiles at time points. RESULTS The Bayesian models demonstrated evidence for individuals with AN having higher scores for a component representing psycho-social difficulties and lower scores for a component representing biological difficulties compared to HC, at both time points. There was no evidence of a group difference for a component representing autism. CONCLUSIONS Our results demonstrate that persistent psycho-social difficulties are a feature in individuals with AN.
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Affiliation(s)
- Daniel Halls
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Rachel Batchelor
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Victoria Holetic
- South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK; South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK; Psychology Department, Illia State University, Tbilisi, Georgia.
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Davey E, Allen K, Bennett SD, Bryant‐Waugh R, Clarke T, Cooper Z, Dixon‐Ward K, Dudley J, Eisler I, Griffiths J, Hill AJ, Micali N, Murphy R, Picek I, Rea R, Schmidt U, Simic M, Tchanturia K, Traviss‐Turner G, Treasure J, Turner H, Wade T, Waller G, Shafran R. Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective. Eur Eat Disord Rev 2023; 31:577-595. [PMID: 37218053 PMCID: PMC10947440 DOI: 10.1002/erv.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. METHOD In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap. RESULTS Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal. CONCLUSIONS Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.
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Affiliation(s)
- Emily Davey
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Karina Allen
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Sophie D. Bennett
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rachel Bryant‐Waugh
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Tim Clarke
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Norfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Zafra Cooper
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | | | - Jake Dudley
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ivan Eisler
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Jess Griffiths
- NHS England Adult Eating Disorders Co‐Chair Parliamentary Health Service Ombudsman's Delivery GroupRedditchUK
| | - Andrew J. Hill
- Leeds Institute of Health SciencesSchool of MedicineUniversity of LeedsLeedsUK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Mental Health Services of the Capital Region of DenmarkEating Disorders Research UnitBallerup Psychiatric CentreCopenhagenDenmark
| | | | - Ivana Picek
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Kate Tchanturia
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Janet Treasure
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Hannah Turner
- Eating Disorders ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Tracey Wade
- Blackbird InitiativeFlinders Research Institute for Mental Health and WellbeingFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Glenn Waller
- Clinical and Applied Psychology UnitDepartment of PsychologyUniversity of SheffieldSheffieldUK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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Tchanturia K, Croft P, Holetic V, Webb J, Dapelo MM. Positive communication workshops: are they useful for treatment programmes for anorexia nervosa? Front Psychol 2023; 14:1234928. [PMID: 37645066 PMCID: PMC10461805 DOI: 10.3389/fpsyg.2023.1234928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Background Social isolation, loneliness and difficulties in relationships are often described as a core feature of eating disorders. Based on the experimental research, we have designed one-off workshops for patients in inpatients and day care services and evaluated its acceptability and effectiveness using feedback questionnaires. Methods This naturalistic project is an evaluation of multiple positive communication workshops. Forty-one participants completed workshop questionnaires, which were provided immediately at the beginning and end of the workshop, including feedback on these one-off groups. The workshops consisted of educational and experiential components. The questionnaire outcomes were evaluated by independent researchers. Results All participants were female adults with a mean age of 33 (12.2) and a diagnosis of Anorexia Nervosa (AN; either restrictive or binge-purge subtype). Post-workshop questionnaires showed large effect sizes in the improvement of understanding the importance and confidence in using positive communication strategies. Discussion Addressing social communication difficulties in eating disorder treatment programmes adds valuable dimensions to these symptom-based treatments in both inpatient settings and day services, and may provide broader benefits in overall social functioning in patients with AN. Conclusion Brief one-off workshops targeting social functioning for patients with eating disorders might be useful complementary input for treatment programmes.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Philippa Croft
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Victoria Holetic
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jessica Webb
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Marcela Marin Dapelo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
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7
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Li Z, Holetic V, Webb J, Chubinidze D, Byford S, Tchanturia K. In-person and online sensory wellbeing workshop for eating disorders: updated case series. J Eat Disord 2023; 11:117. [PMID: 37443135 DOI: 10.1186/s40337-023-00834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND A one-off sensory wellbeing workshop has been developed to help patients with eating disorders (ED) manage sensory sensitivities. The aim of this study was to evaluate and compare the outcomes of the workshop in online versus face-to-face (F2F) formats among a sample of patients with ED. METHODS Cumulative link models were applied to the outcome measures (awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing) to test the differences between online and F2F workshops. Participants' ratings of usefulness of the workshop were also compared between online and F2F workshops. RESULTS A total of 14 workshops (4 online and 10 F2F) were run from 2020 to 2023. All participants reported significant and substantial improvements in all outcome measures. There was no significant difference in outcomes between online and F2F workshops. The majority of patients rated the workshops as useful. CONCLUSIONS Both online and face-to-face formats of the sensory workshop led to improvement in sensory wellbeing management for patients with ED. Future studies are warranted to test the impact of the workshop on ED treatment outcomes.
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Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Victoria Holetic
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dimitri Chubinidze
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Tbilisi Ilia State University, Tbilisi, Georgia
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK.
- Tbilisi Ilia State University, Tbilisi, Georgia.
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Hutchings-Hay C, Dapelo MM, Briceño G, Fernández C, Tchanturia K. Pilot study of facial and bodily feedback. Neuropsychiatr 2023; 37:80-87. [PMID: 36018476 PMCID: PMC10238286 DOI: 10.1007/s40211-022-00426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/16/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND The modulation hypothesis of facial feedback has not adequately examined how combining facial expressions and bodily postures might influence our experience of emotional stimuli. This pilot study examined a new method for manipulating both face and body together, which is important in furthering our understanding of how face and body interact to influence emotional experiences in the real world. METHODS Using a within-subjects design, 30 participants viewed positive film clips under four conditions: (1) positive face with positive body (PP), (2) positive face with neutral body (PN), (3) neutral face with positive body (NP) and (4) neutral face with neutral body (NN). Measures of positive and negative affect were taken before and after each clip, to assess the subjective emotional experience. RESULTS Repeated-measures analysis of variance (ANOVA) was conducted to examine differences in the emotional experience under each condition. Post hoc pairwise comparisons demonstrated that positive affect in the PP condition was significantly higher than in the NP and NN conditions. There was no significant difference between the PP and NN conditions. CONCLUSION Whilst the study findings are difficult to interpret, this pilot study generated a number of important methodological learnings that are relevant to future research of this kind.
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Affiliation(s)
| | - Marcela M Dapelo
- Eating Behaviour Program, Mental Health Service, Clinica Universidad de los Andes, Santiago, Chile
| | - Gisselle Briceño
- School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Camila Fernández
- School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, London, UK
- Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
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Krug I, Linardon J, Greenwood C, Youssef G, Treasure J, Fernandez-Aranda F, Karwautz A, Wagner G, Collier D, Anderluh M, Tchanturia K, Ricca V, Sorbi S, Nacmias B, Bellodi L, Fuller-Tyszkiewicz M. A proof-of-concept study applying machine learning methods to putative risk factors for eating disorders: results from the multi-centre European project on healthy eating. Psychol Med 2023; 53:2913-2922. [PMID: 34842131 DOI: 10.1017/s003329172100489x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite a wide range of proposed risk factors and theoretical models, prediction of eating disorder (ED) onset remains poor. This study undertook the first comparison of two machine learning (ML) approaches [penalised logistic regression (LASSO), and prediction rule ensembles (PREs)] to conventional logistic regression (LR) models to enhance prediction of ED onset and differential ED diagnoses from a range of putative risk factors. METHOD Data were part of a European Project and comprised 1402 participants, 642 ED patients [52% with anorexia nervosa (AN) and 40% with bulimia nervosa (BN)] and 760 controls. The Cross-Cultural Risk Factor Questionnaire, which assesses retrospectively a range of sociocultural and psychological ED risk factors occurring before the age of 12 years (46 predictors in total), was used. RESULTS All three statistical approaches had satisfactory model accuracy, with an average area under the curve (AUC) of 86% for predicting ED onset and 70% for predicting AN v. BN. Predictive performance was greatest for the two regression methods (LR and LASSO), although the PRE technique relied on fewer predictors with comparable accuracy. The individual risk factors differed depending on the outcome classification (EDs v. non-EDs and AN v. BN). CONCLUSIONS Even though the conventional LR performed comparably to the ML approaches in terms of predictive accuracy, the ML methods produced more parsimonious predictive models. ML approaches offer a viable way to modify screening practices for ED risk that balance accuracy against participant burden.
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Affiliation(s)
- I Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - J Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - C Greenwood
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - G Youssef
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - F Fernandez-Aranda
- Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- Consorcio CIBER, Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - A Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - G Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - D Collier
- SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, UK
- Discovery Neuroscience Research, Eli Lilly and Company Ltd, Lilly Research Laboratories, Erl Wood Manor, Surrey, UK
| | - M Anderluh
- Department of Child Psychiatry, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - K Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - V Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - B Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - L Bellodi
- Department of Neuropsychiatric Sciences, Fondazione Centro San Raffaele del Monte Tabor, Milan, Italy
| | - M Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Australia
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10
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Keeler JL, Konyn CY, Treasure J, Cardi V, Himmerich H, Tchanturia K, Mycroft H. "Your mind doesn't have room for anything else": a qualitative study of perceptions of cognitive functioning during and after recovery from anorexia nervosa. J Eat Disord 2022; 10:201. [PMID: 36575533 PMCID: PMC9793561 DOI: 10.1186/s40337-022-00723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Past research has indicated the presence of cognitive difficulties in individuals with anorexia nervosa (AN), although it is unclear how these are experienced in real life. Moreover, it is unclear how and whether the experience of cognitive difficulties changes in nature and intensity over the course of the illness and following recovery. METHODS Twenty-one female participants (AN = 11; recovered AN = 10) participated in online semi-structured interviews, utilising open-ended questions and exploring topics relating to their experiences of their cognitive function, changes over time and their perspectives on the future. Reflexive thematic analysis was conducted on the resulting transcripts. RESULTS Six themes were identified, centred around the effects of the illness on mental and physical function, cognition, adaptation to living with the illness, similarities between AN and other psychopathology, tentative optimism for the future and recovery as a representation of liberation. Whilst respondents with AN appeared to perform remarkably well in their professional and educational lives, the cognitive difficulties were described as significantly impacting their ability to engage in life, particularly in the context of leisure and socialising. Respondents recovered from AN noted the importance of developing a non-AN identity as well as better emotion-regulation skills as central to recovery. CONCLUSIONS Whilst people with AN may be able to adapt their lives to the demands of the illness, they report significant cognitive difficulties that interfere with their engagement in many aspects of daily life. This should be considered by professionals working in the clinical management of AN. Treatments focused on ameliorating cognitive difficulties, and promoting emotional regulation and identity in AN are warranted.
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Affiliation(s)
- Johanna Louise Keeler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.
| | - Carol Yael Konyn
- Department of Social, Genetic & Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Department of General Psychology, University of Padova, Padua, Italy
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 103 Denmark Hill, Section of Eating Disorders, London, SE5 8AF, UK.,Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.,Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Hazel Mycroft
- School of Psychology, University of Exeter, Exeter, Devon, UK
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11
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Keeler JL, Peters-Gill G, Treasure J, Himmerich H, Tchanturia K, Cardi V. Difficulties in retrieving specific details of autobiographical memories and imagining positive future events in individuals with acute but not remitted anorexia nervosa. J Eat Disord 2022; 10:172. [PMID: 36401319 PMCID: PMC9675114 DOI: 10.1186/s40337-022-00684-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The factors that contribute to the maintenance of anorexia nervosa (AN) are not fully understood, although it is generally accepted that depression is a core feature and contributes to poor prognosis. Individuals with depression tend to have difficulties in producing specific details of autobiographical memories and future episodes. Our aim was to investigate autobiographical memory and episodic future thinking (EFT) in individuals with AN (n = 46), people recovered from AN (recAN; n = 40), and non-affected controls (n = 35). METHOD Using a remotely administered computerised version of the autobiographical memory test and episodic future thinking task, we measured six aspects of memory retrieval and EFT generation: specificity, detailedness, difficulty in remembering/imagining, positivity, vividness and realism. Memory and EFT cue valence was manipulated; cues were either positive, neutral, or disorder-related/negative. As the production of EFTs is theoretically linked to the ability to retrieve autobiographical memories, the relationship between autobiographical memory specificity and EFT specificity was explored. To investigate whether autobiographical memory and EFT performance were independent of performance on other forms of cognition, working memory, verbal fluency and cognitive flexibility were measured. RESULTS People with AN had difficulties retrieving specific details of autobiographical memories and rated autobiographical memories as less positive overall, and less vivid when primed by positive cues. People with a lifetime diagnosis (currently ill or recovered) reported greater difficulty in retrieving memories. The AN group generated less positive EFTs, particularly to positive and neutral cues. Comorbid depressive symptoms had some contribution to the observed findings. Lastly, in all groups autobiographical memory specificity predicted EFT specificity. DISCUSSION Problems with retrieving specific details of autobiographical memories and simulating positive EFTs may be a state feature of AN. Treatments targeted at alleviating depressive symptoms, as well those targeted towards facilitating memory retrieval or reconsolidation, and the construction of positive EFTs, may contribute to hope for recovery and strengthen the sense of self beyond the disorder.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | | | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK.,Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.,Department of General Psychology, University of Padova, Padua, Italy
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12
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Kerr-Gaffney J, Jones E, Mason L, Hayward H, Murphy D, Loth E, Tchanturia K. Social attention in anorexia nervosa and autism spectrum disorder: Role of social motivation. Autism 2022; 26:1641-1655. [PMID: 34845940 PMCID: PMC9483678 DOI: 10.1177/13623613211060593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LAY ABSTRACT Research suggests a relationship between autism and anorexia nervosa. For example, rigid and inflexible behaviour, a preference for routine and social difficulties are seen in both conditions. In this study, we examined whether people with anorexia and people with autism show similarities in social attention (where they look while engaging in social interactions or watching a scene with people interacting). This could help us understand why people with anorexia and autism experience difficulties in social situations. Participants with either anorexia or autism, as well as participants with no mental health problems watched a video of a social scene while we recorded which parts of the scene they looked at with an eye-tracker. Participants also completed questionnaires to assess characteristics of autism. We found that autistic participants looked at faces less than typically developing participants. However, participants with anorexia did not show a similar reduction in attention to faces, contrary to our predictions. Autistic features were not related to attention in either group. The results suggest that autistic people may miss important social cues (like facial expressions), potentially contributing to social difficulties. However, this mechanism does not appear explain social difficulties in people with anorexia.
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Affiliation(s)
| | | | | | | | | | | | - Kate Tchanturia
- King’s College London, UK
- South London and Maudsley NHS
Trust, UK
- Ilia State University,
Georgia
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13
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Abstract
OBJECTIVE We are pleased to introduce this special issue about Autism and Feeding and Eating Disorders, representing reflections on this complex comorbidity. METHOD Contributions focussed on several main themes: (1) the definition and assessment of autism and eating disorder (ED) comorbidity; (2) the brain imaging findings of similarities and differences between autism and EDs; (3) sensory systems and interoception; (4) comorbidity across the age spectrum and (5) improving treatment outcomes in ED and autism comorbidity. RESULTS The papers in this issue highlight the importance of research, screening and practical adaptations in the field of ED and autism comorbidity. Autism is a neurodevelopmental condition with several strengths and weaknesses. When patients present with this comorbidity, it is important that their ED is treated which requires careful adaptation and tailoring for people with autism. DISCUSSION This special issue is an attempt to facilitate further research and stimulate collaborations between all of the stakeholders, particularly clinicians who have expertise in autism and clinicians working in the field of ED. We have included diverse themes from international researchers conducting qualitative and quantitative studies, providing research evidence to inform treatment modifications for this complex comorbidity.
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Affiliation(s)
- 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, Eating Disorders National Service, London, UK
- Illia State University, Tbilisi, Georgia
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14
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Halls D, Leppanen J, Kerr‐Gaffney J, Simic M, Nicholls D, Mandy W, Williams S, Tchanturia K. Examining the relationship between autistic spectrum disorder characteristics and structural brain differences seen in anorexia nervosa. Eur Eat Disord Rev 2022; 30:459-473. [PMID: 35570362 PMCID: PMC9546313 DOI: 10.1002/erv.2910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
Abstract
Cortical differences have been reported in Anorexia Nervosa (AN) compared with healthy controls (HC); however, it is unclear if Autism Spectrum Disorder (ASD) characteristics are related to these cortical differences. The aim of this study was to examine if structural measures were correlated to ASD traits in AN. In total 184 female participants participated in the study; 57 acutely underweight AN participants (AAN), 59 weight-restored participants (WR) and 68 HC. Participants underwent structural magnetic resonance imaging as well as completing the Autism Diagnostic Observation schedule, second edition to examine ASD characteristics. Group differences in curvature, gyrification, surface area, thickness, global grey matter and white matter were measured. Correlation and regression analysis were conducted to examine the relationship between cortical measures and ASD characteristics. Two decreased gyrification clusters in the right post central and supramarginal gyrus and decreased global grey matter were observed in the AAN group compared to HC and WR. No correlations between ASD traits and structural measures existed. Our results suggest structural differences seen in individuals with AN do not appear to be related to ASD characteristics.
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Affiliation(s)
- Daniel Halls
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Jenni Leppanen
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Jess Kerr‐Gaffney
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
| | - Mima Simic
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Steven Williams
- King's College LondonCentre for Neuroimaging SciencesLondonUK
| | - Kate Tchanturia
- King's College London (KCL), Institute of PsychiatryPsychology and Neuroscience (IoPPN)Psychological MedicineLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
- Psychology DepartmentIllia State UniversityTbilisiGeorgia
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15
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Sedgewick F, Leppanen J, Austin A, Tchanturia K. Different pathways, same goals: A large-scale qualitative study of autistic and non-autistic patient-generated definitions of recovery from an eating disorder. Eur Eat Disord Rev 2022; 30:580-591. [PMID: 34820930 DOI: 10.1002/erv.2873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Definitions of recovery from an eating disorder (ED) have generally been formulated around clinical conceptualisations, rather than based on the views of patients. This paper therefore asked those with lived experience of ED for their own definitions of recovery. METHOD Data were collected as part of an online study looking at EDs, autism and relationships. About 173 participants identified as recovered from ED and gave free-response definitions of recovery. Responses were subject to thematic analysis. RESULTS Seven major themes were identified: Weight restoration, lack of ED behaviours, thoughts and behaviours, cognitions, emotional responses, getting on with life, and ongoing challenges. CONCLUSIONS Many definitions of recovery given by those who have lived experience of ED echoed those used by clinicians and researchers. There were also points of divergence around the ongoing challenges of recovery. Our findings highlight the need for continuing support post-weight restoration to facilitate the successful long-term recovery for those with ED.
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Affiliation(s)
- Felicity Sedgewick
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Education, University of Bristol, Bristol, UK
| | - Jenni Leppanen
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amelia Austin
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Illia State University, Tbilisi, Georgia
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16
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Giombini L, Nesbitt S, Kusosa R, Hinallas K, Fabian C, Easter A, Tchanturia K. Young people and parents' views towards individual cognitive remediation therapy-qualitative findings from a feasibility randomised controlled trial. Eat Weight Disord 2022; 27:2237-2244. [PMID: 35037189 DOI: 10.1007/s40519-021-01346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Cognitive Remediation Therapy (CRT) has been used mostly in adults. Randomised Controlled Trials (RCTs) in anorexia nervosa (AN) have shown that CRT enhances cognitive flexibility, abstract thinking and is associated with quality-of-life improvement. More research is needed in younger populations. METHODS A single-centre feasibility RCT with young people (YP) with AN was conducted in an inpatient setting. A secondary aim of this study was to explore patient satisfaction and parents' views towards CRT to inform further development and implementation of CRT in YP. YP were asked to complete a therapy feedback questionnaire and write a letter with their views on CRT. Parents were asked to complete a questionnaire exploring their perceptions of CRT. Data were analysed using inductive thematic and deductive content analysis. RESULTS Both YP and parents valued CRT. Its engaging and pragmatic nature and its focus on thinking styles were perceived as a novel aspect. Parents expressed the need to be involved in the sessions to be able to continue to support their children at home. CONCLUSIONS This study confirms previous qualitative findings. Should a fully powered RCT be conducted, it would be important to take into account these findings to further adapt the content of the CRT sessions to the YP needs and to consider their parents' involvement in the sessions, which could also increase the likelihood of parents' engagement in providing their feedback. LEVEL OF EVIDENCE Level I: Evidence obtained from one randomized controlled trial.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK.
- Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, PO59 King's College London, London, SE58AF, UK.
| | - Sophie Nesbitt
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Rutendo Kusosa
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Katerina Hinallas
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Cleo Fabian
- Rhodes Wood Hospital, Elysium Healthcare, Shepherd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, PO59 King's College London, London, SE58AF, UK
- Department of Psychology, Illia University Tbilisi Georgia, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
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17
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Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry 2022; 13:793094. [PMID: 35280172 PMCID: PMC8904925 DOI: 10.3389/fpsyt.2022.793094] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Background Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology. Methodology A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency. Results The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI. Discussion The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Dalia Brown
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Hannah McLinden
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust National Eating Disorder Service, London, United Kingdom
- Psychology Department, Illia State University, Tbilisi, Georgia
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18
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Li Z, Hutchings-Hay C, Byford S, Tchanturia K. How to support adults with anorexia nervosa and autism: Qualitative study of clinical pathway case series. Front Psychiatry 2022; 13:1016287. [PMID: 36440425 PMCID: PMC9691948 DOI: 10.3389/fpsyt.2022.1016287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Previous research has explored the overlapping presentation between autism and eating disorders (ED). This study aims to summarize the clinical challenges associated with co-occurring autism and anorexia nervosa (AN) based on clinicians' case notes and minutes from case discussions, to understand how to better support people with the comorbidity. METHOD Thematic analysis was conducted on de-identified notes on 20 cases with AN and autistic characteristics and minutes from case discussions. Themes relevant to clinical challenges in supporting those with the comorbidity were identified, and a thematic map was produced to visually represent the results. RESULTS The key challenges faced by clinicians when treating patients with AN and autism included: communication difficulties, maintaining boundaries, autism screening, presence of other comorbidities, sensory difficulties, atypical presentation of eating difficulties, cognitive rigidity, and emotional difficulties. Adaptations to resolve some of these difficulties included exposure-based food experiments, keeping a record of patients' self-reported communication preferences, individual-level modification of communication style, and providing tools for patients to identify emotions. CONCLUSIONS AND IMPLICATIONS Further exploration to establish the effectiveness of the adaptations is warranted. Furthermore, tools for differentiating between ED, autism and other comorbidities are needed to help clinicians clarify the cause of a presenting symptom, and help them to best support and maintain boundaries with patients.
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Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Chloe Hutchings-Hay
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sarah Byford
- King's Health Economics, Department of Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Tbilisi State Medical University, Psychological Set Research and Correction Center, Tbilisi, Georgia
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19
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Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes. Front Psychiatry 2022; 13:985867. [PMID: 36213911 PMCID: PMC9533087 DOI: 10.3389/fpsyt.2022.985867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, elevated levels of autistic features and autism diagnoses have been reported among people with anorexia nervosa (AN). In clinical settings high levels of autistic features have been linked to more complex, highly comorbid illness presentation and poorer treatment outcome. This study aimed to examine whether autistic features predict AN symptom profile in long term. METHODS Altogether 118 women with lived experience of AN completed two autism assessments at time 1, the Autism Diagnostic Observation Schedule (ADOS) and the short version of the Autism Quotient (AQ10). Measures assessing AN symptom profile, including eating disorders symptoms, anxiety, depression, OCD symptoms, and Body Mass Index (BMI), were also recorded. The symptom profile measures were administered again 6 months and 2 years later. We conducted two analyses to examine the extent to which the ADOS and AQ10 scores predicted broad AN symptom profile at each three time points. RESULTS Overall, high levels of autistic features were consistently associated with worse psychological symptoms, but not BMI, across all time points. Both the analysis using baseline ADOS scores and self-reported AQ10 scores showed similar pattern. CONCLUSION The present findings consolidate previously reported associations between autistic features and worse psychological outcome among people with AN. The findings also suggest that self-report measures may be sufficient for assessing the impact of autistic features on illness outcome among people with AN. Importantly, the study highlights the need for development and further investigation of neurodiversity accommodations in the treatment of AN.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | | | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, United Kingdom.,Department of Psychology, Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
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20
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Baenas I, Etxandi M, Munguía L, Granero R, Mestre-Bach G, Sánchez I, Ortega E, Andreu A, Moize VL, Fernández-Real JM, Tinahones FJ, Diéguez C, Frühbeck G, Le Grange D, Tchanturia K, Karwautz A, Zeiler M, Imgart H, Zanko A, Favaro A, Claes L, Shekriladze I, Serrano-Troncoso E, Cecilia-Costa R, Rangil T, Loran-Meler ME, Soriano-Pacheco J, Carceller-Sindreu M, Navarrete R, Lozano M, Linares R, Gudiol C, Carratala J, Plana MT, Graell M, González-Parra D, Gómez-del Barrio JA, Sepúlveda AR, Sánchez-González J, Machado PPP, Håkansson A, Túry F, Pászthy B, Stein D, Papezová H, Gricova J, Bax B, Borisenkov MF, Popov SV, Gubin DG, Petrov IM, Isakova D, Mustafina SV, Kim YR, Nakazato M, Godart N, van Voren R, Ilnytska T, Chen J, Rowlands K, Voderholzer U, Monteleone AM, Treasure J, Jiménez-Murcia S, Fernández-Aranda F. Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study. Nutrients 2021; 14:nu14010100. [PMID: 35010974 PMCID: PMC8746935 DOI: 10.3390/nu14010100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background. The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. Aims. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. Methods. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Results. Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. Conclusions. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.
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Affiliation(s)
- Isabel Baenas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Mikel Etxandi
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
| | - Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Psychobiology and Methodology, School of Psychology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, 26006 La Rioja, Spain;
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain; (E.O.); (A.A.); (V.L.M.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Alba Andreu
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain; (E.O.); (A.A.); (V.L.M.)
| | - Violeta L. Moize
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), 08036 Barcelona, Spain; (E.O.); (A.A.); (V.L.M.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Jose-Manuel Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta-Institut d’Investigació Biomèdica de Girona (IDIBGI), 17007 Girona, Spain
- Department of Medical Sciences, School of Medicine, University of Girona, 17004 Girona, Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital-Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Carlos Diéguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, 15782 Santiago de Compostela, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, 31008 Pamplona, Spain
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, CA 94143, USA;
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK; (K.T.); (K.R.); (J.T.)
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.K.); (M.Z.)
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, 1090 Vienna, Austria; (A.K.); (M.Z.)
| | - Hartmut Imgart
- Parkland Klinik, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Annika Zanko
- Parkland Klinik, 34537 Bad Wildungen, Germany; (H.I.); (A.Z.)
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), 35122 Padua, Italy;
| | - Laurence Claes
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium;
- Clinical Psychology, Faculty of Medicine and Health Sciences, University Antwerp, 2000 Antwerp, Belgium
| | - Ia Shekriladze
- D. Uznadze Institute of Psychology, Ilia State University, 0162 Tbilisi, Georgia;
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (R.C.-C.)
| | - Raquel Cecilia-Costa
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu- Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain; (E.S.-T.); (R.C.-C.)
| | - Teresa Rangil
- Department of Psychiatry, Germans Trias i Pujol University Hospital-IGTP, 08916 Barcelona, Spain; (T.R.); (M.E.L.-M.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Maria Eulalia Loran-Meler
- Department of Psychiatry, Germans Trias i Pujol University Hospital-IGTP, 08916 Barcelona, Spain; (T.R.); (M.E.L.-M.)
| | - José Soriano-Pacheco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau)-Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain; (J.S.-P.); (M.C.-S.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain; (M.T.P.); (M.G.); (J.A.G.-d.B.)
| | - Mar Carceller-Sindreu
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau (IIB-Sant Pau)-Universitat Autònoma de Barcelona (UAB), 08041 Barcelona, Spain; (J.S.-P.); (M.C.-S.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain; (M.T.P.); (M.G.); (J.A.G.-d.B.)
| | - Rosa Navarrete
- Centro de Diagnóstico de Enfermedades Moleculares, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | | | | | - Carlota Gudiol
- Infectious Diseases Department, Hospital Universitari Bellvitge-Institut de Investigació Biomedica de Bellvitge (IDIBELL)-Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (C.G.); (J.C.)
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jordi Carratala
- Infectious Diseases Department, Hospital Universitari Bellvitge-Institut de Investigació Biomedica de Bellvitge (IDIBELL)-Institut Català d’Oncologia-Hospitalet, 08908 Barcelona, Spain; (C.G.); (J.C.)
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Maria T. Plana
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain; (M.T.P.); (M.G.); (J.A.G.-d.B.)
- Institute of Neuroscience, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic de Barcelona, 08036 Barcelona, Spain
| | - Montserrat Graell
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain; (M.T.P.); (M.G.); (J.A.G.-d.B.)
- Child and Adolescent Psychiatry and Psychology Service, Child Hospital Niño Jesus, 28009 Madrid, Spain
| | - David González-Parra
- Psychiatry Service, University of Salamanca Healthcare Complex (USHC)-Institute of Biomedicine of Salamanca (IBSAL)-University of Salamanca, 37008 Salamanca, Spain;
| | - José A. Gómez-del Barrio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, 28029 Madrid, Spain; (M.T.P.); (M.G.); (J.A.G.-d.B.)
- Unidad de Trastornos de la Conducta Alimentaria, Hospital Universitario “Marqués de Valdecilla”, Avda, Valdecilla s/n, 39011 Santander, Spain
- Instituto de Investigación Valdecilla (IDIVAL), 39011 Santander, Spain
| | - Ana R. Sepúlveda
- Facultad de Psicología, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Jéssica Sánchez-González
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
| | - Paulo P. P. Machado
- Psychotherapy and Psychopathology Research Unit—Psychology Research Center, School of Psychology, University of Minho, 4710-057 Braga, Portugal;
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, 221 00 Lund, Sweden;
- Gambling Disorder Unit, Malmö Addiction Center, 205 02 Malmö, Sweden
| | - Ferenc Túry
- Institute of Behavioral Sciences, Semmelweis University, 1085 Budapest, Hungary;
| | - Bea Pászthy
- 1st Department of Paediatrics, Semmelweis University, 1085 Budapest, Hungary;
| | - Daniel Stein
- Safra Children’s Hospital, Chaim Sheba Medical Center, Tel Hashomer 52 621, Israel;
| | - Hana Papezová
- Department of Psychiatry, 1st Medical Faculty of Charles University, 11000 Prague, Czech Republic; (H.P.); (J.G.)
| | - Jana Gricova
- Department of Psychiatry, 1st Medical Faculty of Charles University, 11000 Prague, Czech Republic; (H.P.); (J.G.)
| | - Brigita Bax
- Eating Disorders Center, Vilnius University Vilnius, 01513 Vilnius, Lithuania;
| | - Mikhail F. Borisenkov
- Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 167982 Syktyvkar, Russia; (M.F.B.); (S.V.P.)
| | - Sergey V. Popov
- Institute of Physiology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 167982 Syktyvkar, Russia; (M.F.B.); (S.V.P.)
| | - Denis G. Gubin
- Laboratory for Chronobiology and Chronomedicine, Department of Biology, Tyumen State Medical University, 625023 Tyumen, Russia;
- Tyumen Cardiology Research Institute, Tomsk Research Medical Center, 634009 Tyumen, Russia
| | - Ivan M. Petrov
- Department of Biological & Medical Physics UNESCO, Tyumen State Medical University, 625023 Tyumen, Russia;
| | - Dilara Isakova
- Department of Therapy and Endocrinology, Tyumen State Medical University, 625023 Tyumen, Russia;
| | - Svetlana V. Mustafina
- Institute of Internal and Preventive Medicine–Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia;
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital-Inje University, Seoul 01757, Korea;
| | - Michiko Nakazato
- Department of Psychiatry, School of Medicine, International University of Health and Welfare, Narita 286-8686, Japan;
| | - Nathalie Godart
- CESP, Université Paris-Saclay, UVSQ, INSERM U 1178, 94805 Villejuif, France;
- Department of Psychiatry, Institut Mutualiste Montsouris, School of Medicine, Université Paris Descartes, 75006 Paris, France
- UFR des Sciences de la Santé Simone Veil (UVSQ), Praticienne Hospitalière, Fondation Santé des Etudiants de France, 78180 Paris, France
| | - Robert van Voren
- Department of Political Science, Vytautas Magnus University, 44248 Kaunas, Lithuania;
| | - Tetiana Ilnytska
- Institute of Psychiatry of Taras Shevchenko, National University of Kyiv, 01033 Kyiv, Ukraine;
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 280, Shanghai 200030, China;
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK; (K.T.); (K.R.); (J.T.)
| | | | - Alessio M. Monteleone
- Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Universitá degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK; (K.T.); (K.R.); (J.T.)
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (S.J.-M.); (F.F.-A.); Tel.: +34-93-260-7227 (S.J.-M. & F.F.-A.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 Barcelona, Spain; (I.B.); (M.E.); (L.M.); (I.S.); (J.S.-G.)
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Barcelona, Spain; (R.G.); (J.-M.F.-R.); (F.J.T.); (C.D.); (G.F.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (S.J.-M.); (F.F.-A.); Tel.: +34-93-260-7227 (S.J.-M. & F.F.-A.)
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Li Z, Halls D, Byford S, Tchanturia K. Autistic characteristics in eating disorders: Treatment adaptations and impact on clinical outcomes. Eur Eat Disord Rev 2021; 30:671-690. [PMID: 34850503 DOI: 10.1002/erv.2875] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Autistic people with eating disorders (EDs) may have special needs that are not met in standard ED treatment, raising the need for treatment adaptations to accommodate co-existing autism spectrum condition (ASC). Little is currently known about the nature of existing treatment options or adaptations for this population. We conducted a pre-registered systematic review to: (1) identify research articles describing existing interventions for patients with ED and comorbid ASC, and to critically review evidence of their clinical effectiveness and cost-effectiveness (Review 1); (2) review the impact of ASC comorbidity on ED clinical outcomes (Review 2). METHOD Peer-reviewed studies published until the end of December 2020 were identified through a systematic search of the electronic databases: Medline, Embase, PsycINFO, Web of Science, CINAHL, Scopus and Cochrane Library. RESULTS Only one clinical pathway of treatment adaptations (the 'PEACE' pathway) was identified in Review 1 with early evidence of cost-savings and favourable treatment outcomes. ASC characteristics were shown in Review 2 to have no direct impact on physical outcomes or ED symptoms, but could be associated with higher rates of comorbidities and greater use of intensive ED treatment. Additionally, patients with ASC characteristics may benefit more from individual sessions, rather than group sessions. CONCLUSIONS Any new treatments or treatment adaptations may not directly impact on ED symptoms, but may be better able to support the complex needs of the ASC population, thus reducing subsequent need for intensive treatment. Future research is warranted to explore evidence of clinical and cost-effectiveness of interventions for this population.
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Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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22
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Giombini L, Nesbitt S, Kusosa R, Fabian C, Sharia T, Easter A, Tchanturia K. Neuropsychological and clinical findings of Cognitive Remediation Therapy feasibility randomised controlled trial in young people with anorexia nervosa. Eur Eat Disord Rev 2021; 30:50-60. [PMID: 34821431 DOI: 10.1002/erv.2874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Randomised controlled trial (RCT) in adults with anorexia nervosa (AN) showed that Cognitive Remediation Therapy (CRT) enhances cognitive flexibility, abstract thinking and quality-of-life. Despite inconsistent findings, CRT has the potential as an adjunct treatment for young people (YP) with AN. A feasibility RCT was conducted in an inpatient setting. The study will also consider the effect of CRT in YP with AN and autistic symptoms. METHODS Participants were randomly allocated to the Immediate or Delayed condition to receive individual CRT sessions, in addition to standard treatment. A repeated measures design was conducted. RESULTS Eighty participants were recruited. The neuropsychological measures were feasible for evaluating individual CRT in YP. Significant improvements in set-shifting and central coherence were found, with no main effect between immediate and delayed condition. Significant interactions were found between the condition, and autism spectrum condition (ASC) and No-ASC subgroup, with significant positive impact of CRT on set-shifting in the No-ASC subgroup. There was some evidence that for the No-ASC subgroup, CRT was more effective if delivered at the start of the treatment; and for the ASC subgroup, that CRT was more effective if delivered at the later stage of treatment. CONCLUSIONS These findings suggest that the overall positive effect of CRT in set-shifting and central coherence alongside standard treatment. They also indicate the importance of screening for the presence of ASC which could require tailored CRT.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, London, UK.,Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK
| | | | | | - Cleo Fabian
- Rhodes Wood Hospital, Elysium Healthcare, London, UK
| | - Teo Sharia
- Department of Mathematics, Royal Holloway University of London, Egham, Surrey, UK
| | - Abigail Easter
- Department of Women and Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK.,Department of Psychology, Illia University Tbilisi, Tbilisi, Georgia.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
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Claes L, Favaro A, Karwautz A, Le Grange D, Tchanturia K, Treasure J. The 'Good European': A tribute to Fernando Fernandez-Aranda editor in chief of the European Eating Disorder review 2011-2021. Eur Eat Disord Rev 2021; 29:985-986. [PMID: 34668268 DOI: 10.1002/erv.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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24
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Onwumere J, Creswell C, Livingston G, Shiers D, Tchanturia K, Charman T, Russell A, Treasure J, Di Forti M, Wildman E, Minnis H, Young A, Davis A, Kuipers E. COVID-19 and UK family carers: policy implications. Lancet Psychiatry 2021; 8:929-936. [PMID: 34537103 PMCID: PMC8445736 DOI: 10.1016/s2215-0366(21)00206-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/25/2022]
Abstract
Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.
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Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.
| | - Cathy Creswell
- Department of Experimental Psychology, and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health Trust, Manchester, UK; Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Primary Care and Health Sciences, Keele University, Keele, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alisa Russell
- Department of Psychology, Centre of Applied Autism Research, University of Bath, Bath, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Department of Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emilie Wildman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen Minnis
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, UK
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annette Davis
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
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Datta N, Foukal M, Erwin S, Hopkins H, Tchanturia K, Zucker N. A mixed-methods approach to conceptualizing friendships in anorexia nervosa. PLoS One 2021; 16:e0254110. [PMID: 34525111 PMCID: PMC8443043 DOI: 10.1371/journal.pone.0254110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Individuals with anorexia nervosa have reported feelings of loneliness, social anhedonia, and interpersonal difficulties. This study sought to clarify the nature of interpersonal relationships in adults with anorexia, which may help improve existing interventions while also facilitating the attainment of something that might compete with the drive for thinness: friendships. METHODS The present study used a mixed-methods approach to investigate friendship experiences in three groups: anorexia (n = 27), participants with a history of anorexia who are weight restored (n = 20), and healthy controls (n = 24). Thematic analysis was used to isolate the most prevalent themes that emerged from an open-ended interview of experiencing friendships in a subset of participants. Three self-report questionnaires investigating friendship valuation and attachment styles were also administered. RESULTS 11 unique themes emerged in the data: social comparison, reciprocity, trust, fear of negative evaluation, perceived skills deficit, logistical barriers, reliability, identity issue, low interest, similarity, and conflict avoidance. Only 17% of those with anorexia reported experiencing friendships as positive, relative to 82% of healthy controls and 52% of weight restored participants. Lastly, on self-report measures, participants with anorexia reported greater reliance on themselves versus others, greater use of care-seeking behaviors, and more fear/anger at the thought of losing an attachment figure (p < .05 in all cases). CONCLUSION Results suggest that individuals with anorexia have particular challenges which interfere with the formation and maintenance of friendships, such as viewing friendships negatively and struggling with social comparisons in friendships. Assessing and addressing barriers to intimacy may motivate those with anorexia to relinquish dangerous symptoms that maintain the illness.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
| | - Molly Foukal
- Duke University Department of Psychology and Neuroscience, Durham, NC, United States of America
| | - Savannah Erwin
- Duke University Department of Psychology and Neuroscience, Durham, NC, United States of America
| | - Hannah Hopkins
- Duke University Department of Psychology and Neuroscience, Durham, NC, United States of America
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Nancy Zucker
- Duke University Department of Psychology and Neuroscience, Durham, NC, United States of America
- Duke University School of Medicine Department of Psychiatry & Behavioral Sciences, Durham, NC, United States of America
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Leslie M, Halls D, Leppanen J, Sedgewick F, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Williams S, Tchanturia K. The neural correlates of a central coherence task in young women with anorexia nervosa. Eur Eat Disord Rev 2021; 29:744-755. [PMID: 34278640 DOI: 10.1002/erv.2852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. METHODS We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. RESULTS There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. CONCLUSIONS These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.
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Affiliation(s)
- Monica Leslie
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- Department of Psychology, University of Chester, Chester, UK
| | - Daniel Halls
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Jenni Leppanen
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Felicity Sedgewick
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- School of Education, University of Bristol, Bristol, UK
| | - Katie Lang
- Department of Psychology - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Leon Fonville
- Division of Brain Sciences, Imperial College London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, UK
| | - William Mandy
- Research Department of Clinical, Health and Educational Psychology, UCL, London, UK
| | | | - Steven Williams
- Department of Neuroimaging - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
| | - Kate Tchanturia
- Department of Psychological Medicine - London, King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), UK
- Psychology Department, Illia State University, Tbilisi, Georgia
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Kerr-Gaffney J, Halls D, Leppanen J, Tchanturia K. Exploring neuropsychological and socio-emotional task performance in anorexia nervosa: A cluster analytic approach. Eur Eat Disord Rev 2021; 29:802-810. [PMID: 34245076 DOI: 10.1002/erv.2851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to characterise heterogeneity in neuropsychological and socio-emotional task performance in young women with anorexia nervosa (AN) using hierarchical cluster analysis. Further, we aimed to test whether cognitive profiles were associated with differences in clinical variables (body mass index, illness duration and age at diagnosis), psychopathology (eating disorder, autistic symptoms, anxiety and depression) and functional impairment. METHOD Set-shifting, central coherence and theory of mind abilities were measured in 118 women with acute or remitted AN. A hierarchical cluster analysis using Ward's method with a Euclidean distance measure was performed with the neuropsychological and socio-emotional variables. Differences between clusters were assessed using ANOVAs. RESULTS Four clusters emerged, with significant differences in neuropsychological and socio-emotional task performance. There were no significant differences between clusters in clinical variables, psychopathology or functional impairment, however, these analyses lacked power due to small cluster sizes. CONCLUSIONS Our results demonstrate significant heterogeneity in cognitive profiles in AN, supporting a more personalised approach to treatment. Studies in larger samples are required to establish whether these variables map onto clinically significant differences in aetiology, clinical presentation, comorbidity patterns and/or treatment responses.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jenni Leppanen
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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28
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Kerr-Gaffney J, Mason L, Jones E, Hayward H, Harrison A, Murphy D, Tchanturia K. Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa. J Autism Dev Disord 2021; 51:2077-2090. [PMID: 32910314 PMCID: PMC8124046 DOI: 10.1007/s10803-020-04686-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Ilia State University, Tbilisi, GA, USA
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Babb C, Brede J, Jones CRG, Elliott M, Zanker C, Tchanturia K, Serpell L, Mandy W, Fox JRE. 'It's not that they don't want to access the support . . . it's the impact of the autism': The experience of eating disorder services from the perspective of autistic women, parents and healthcare professionals. Autism 2021; 25:1409-1421. [PMID: 33588579 PMCID: PMC8264634 DOI: 10.1177/1362361321991257] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
LAY ABSTRACT This study explores autistic women's experiences of eating disorder services. About 20%-30% of people with anorexia nervosa are also autistic, and current treatments seem not to work as well for them. We interviewed 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 healthcare professionals working in eating disorder services. We asked autistic women and parents about their experiences of eating disorder services, and we asked healthcare professionals about their experiences treating autistic women with anorexia nervosa. Participants' views were represented by three overall themes: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that autistic women face many barriers when in treatment for anorexia nervosa, often because of a lack of autism understanding within eating disorder services. Future research should look at developing anorexia nervosa treatments that can specifically help autistic individuals.
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Affiliation(s)
| | | | | | | | | | | | - Lucy Serpell
- University College London, UK
- Eating Disorder Service, North East London NHS Foundation Trust, Essex, UK
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30
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Mountford VA, Allen KL, Tchanturia K, Eilender C, Schmidt U. Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting. Int J Eat Disord 2021; 54:1238-1249. [PMID: 33719036 DOI: 10.1002/eat.23504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. METHOD Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. RESULTS Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT-ED. DISCUSSION These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.
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Affiliation(s)
- Victoria A Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Cara Eilender
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Clinical Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Kerr-Gaffney J, Hayward H, Jones EJH, Halls D, Murphy D, Tchanturia K. Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder. Mol Autism 2021; 12:47. [PMID: 34193255 PMCID: PMC8247081 DOI: 10.1186/s13229-021-00455-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Recent research suggests a link between autism spectrum disorder (ASD) and anorexia nervosa (AN). Individuals with AN show high scores on measures of ASD symptoms, relative to individuals without AN, however, there are currently no studies directly comparing women with AN to women with ASD. The aim of the current study was to examine profiles of ASD symptoms in young women in the acute and recovered stages of AN, women with ASD, and typically developing controls (TD), on both self-report and clinical interview measures. Methods Four groups of participants aged 12–30 years were included (n = 218): AN, recovered AN (REC), ASD, and TD. Group differences on the Social Responsiveness Scale, 2nd edition (SRS-2), 10-item Autism Quotient (AQ-10), and the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) were examined. To explore similarities and differences in specific symptom profiles associated with AN and ASD, individual item endorsement on the ADOS-2 was also examined in AN, REC, and ASD. Results Across measures, women with ASD showed the highest scores, and TDs the lowest. Generally, individuals with AN and REC showed intermediate levels of ASD symptoms, scoring between the other two groups. However, AN and ASD did not differ on restricted interests and repetitive behaviour subscales. The ADOS-2 item ‘quality of social response’ adequately discriminated between ASD and non-ASD participants. Limitations A full diagnostic assessment for ASD was not provided for participants with AN/REC, nor were eating disorders assessed in the ASD group. Therefore, some diagnostic overlap between groups is possible. The cross-sectional design is another limitation. Conclusions The results suggest similarities in scores on both self-report and clinical interview measures in AN and ASD. However, individual ADOS-2 item analyses also revealed subtle differences, particularly in reciprocal social interaction. ASD symptoms may be a combination of both state and trait features in AN. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00455-5.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.,Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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Tchanturia K, Baillie C, Biggs C, Carr A, Harrison A, Li Z, McFie C, Oyeleye O, Toloza C. Sensory wellbeing workshops for inpatient and day-care patients with anorexia nervosa. Neuropsychiatr 2021; 36:51-59. [PMID: 34129196 PMCID: PMC8204121 DOI: 10.1007/s40211-021-00392-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 12/03/2022]
Abstract
Background The wellbeing of patients with eating disorders is one of the priorities in the “bigger picture” of treatment for eating disorders. Sensory soothing strategies for sensory sensitivities are supportive tools which could be useful in day-care and inpatient clinical programmes. Methods Evaluation of multiple separate sensory wellbeing workshops consisting of psychoeducation and experiential components delivered in inpatient and intensive day-care services was performed. Participants’ self-report questionnaires were evaluated pre- and post-workshop. Additionally, patients’ comments and qualitative feedback was collected after completion of the workshop. Results There was strong evidence that self-reported awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing increased after the workshops with positive qualitative feedback from participants. The feedback questionnaires highlighted that patients found the sessions useful and were able to use some of the skills and strategies they learned in the workshop. Conclusion This pilot work on sensory wellbeing workshops with a protocol-based format was feasible and beneficial for the patient group. Preliminary evidence suggests that delivery of similar workshops could be sensible in addition to treatment as usual in inpatient and day-care programmes.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO59, SE5 8AF, London, UK.
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK.
- Ilia State University, Tbilisi, Georgia.
| | - C Baillie
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - C Biggs
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Carr
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Harrison
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychology and Human Development, University College London, Institute of Education, 25 Woburn Square, WC1H 0AA, London, UK
| | - Z Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO59, SE5 8AF, London, UK
| | - C McFie
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - O Oyeleye
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - C Toloza
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
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Lang K, Kerr-Gaffney J, Hodsoll J, Jassi A, Tchanturia K, Krebs G. Is poor global processing a transdiagnostic feature of Body Dysmorphic Disorder and Anorexia Nervosa? A meta-analysis. Body Image 2021; 37:94-105. [PMID: 33582531 DOI: 10.1016/j.bodyim.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
Body dysmorphic disorder (BDD) and anorexia nervosa (AN) are characterised by body image disturbance. It has been suggested that poor global integration in visual processing may underlie distorted body image, but empirical studies have yielded mixed results. The current study involved two meta-analyses aimed at examining the extent to which poor global processing is evident in BDD and AN. Studies were identified through a systematic literature search up to October 2020. The BDD search yielded 16 studies and the AN search yielded 18 studies. Random-effect models demonstrated a small pooled effect size for BDD (g = -0.44, 95 % CI -0.70, -0.17, p < 0.001) and a moderate pooled effect size for AN (g = -0.63, 95 % CI -0.77, -0.49, p < .001), with no evidence of significant publication bias for either. The results provide evidence that poor global processing is a transdiagnostic feature of both BDD and AN, although effects may be more pronounced in AN. Our findings highlight the possibility that interventions aimed at promoting global visual processing could prove beneficial in disorders characterised by distorted body image.
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Affiliation(s)
- Katie Lang
- King's College London (KCL), Psychology Department, Institute of Psychiatry, UK; National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK.
| | - Jess Kerr-Gaffney
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, UK
| | - John Hodsoll
- King's College London (KCL), Department of Biostatistics, Institute of Psychiatry, UK
| | - Amita Jassi
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK
| | - Kate Tchanturia
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, UK; National Eating Disorder Unit, South London & Maudsley NHS Trust, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; King's College London (KCL), Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, UK
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Tchanturia K, Dandil Y, Li Z, Smith K, Leslie M, Byford S. A novel approach for autism spectrum condition patients with eating disorders: Analysis of treatment cost-savings. Eur Eat Disord Rev 2021; 29:514-518. [PMID: 32648631 DOI: 10.1002/erv.2760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/14/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the current economic context, it is critical to ensure that eating disorder (ED) treatments are both effective and cost-effective. We describe the impact of a novel clinical pathway developed to better meet the needs of autistic patients with EDs on the length and cost of hospital admissions. METHOD The pathway was based on the Institute for Healthcare's Model of Improvement methodology, using an iterative Plan, Do, Study, Act format to introduce change and to co-produce the work with people with lived experience and with healthcare professionals. We explored the change in length and cost of admissions before and after the pathway was introduced. RESULTS Preliminary results suggest that the treatment innovations associated with this pathway have led to reduced lengths of admission for patients with the comorbidity, which were not seen for patients without the comorbidity. Estimated cost-savings were approximately £22,837 per patient and approximately £275,000 per year for the service as a whole. CONCLUSION Going forward, our aim is to continue to evaluate the effectiveness and cost-effectiveness of investment in the pathway to determine whether the pathway improves the quality of care for patients with a comorbid ED and autism and is good value for money.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychology, Illia University, Tbilisi, Georgia
| | - Yasemin Dandil
- King's College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London, UK
| | - Zhuo Li
- King's College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London, UK
| | - Katherine Smith
- King's College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London, UK
| | - Monica Leslie
- King's College London, Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, London, UK
| | - Sarah Byford
- King's College London, Health Service and Population Research Department, Institute of Psychology, Psychiatry and Neuroscience, London, UK
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Leppanen J, Tosunlar L, Blackburn R, Williams S, Tchanturia K, Sedgewick F. Critical incidents in anorexia nervosa: perspectives of those with a lived experience. J Eat Disord 2021; 9:53. [PMID: 33875005 PMCID: PMC8054426 DOI: 10.1186/s40337-021-00409-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although social-emotional difficulties are believed play a key role in anorexia nervosa (AN), there is uncertainty regarding what these difficulties might look like. Previous research has largely focused on a "disease model" of social-emotional processing in AN with little attention paid to positive emotions and experiences. Therefore, the aim of the present study was to obtain a fuller picture of critical life events as identified by those with lived AN experience. METHODS Thirty-four participants aged 16-48 with current or past AN completed an online survey describing self-defined positive and difficult critical events. Thematic analysis was used to assess patterns in participants narrative responses. RESULTS Two major themes were identified in the descriptions of positive critical events: Moments of celebration and Unexpected positive outcomes. These major themes revealed increased external focus and some corrective experiences that challenged the participants pre-existing expectations leading to new positive outcomes. Difficult events clustered into life events that were identified as Eating disorder (ED) related and Non-ED related and included the dimensions of relational conflict and feeling unsupported. DISCUSSION The findings suggest that although negative emotionality was identified in the accounts of those with lived experience of AN capacity for "big-picture" thinking with and explicit focus on others was also identified. Moreover, an openness to corrective experiences that worked to challenge negative expectations was evident for some participants. Together these findings have scope as targets for further clinical research and treatment interventions.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Lara Tosunlar
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Rachael Blackburn
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK
- Psychology Department, Illia State University, Tbilisi, Georgia
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Kinnaird E, Oakley M, Lawrence V, Shergill S, Tchanturia K. A peer interview qualitative study exploring support for carers of people with comorbid autism and eating disorders. J Eat Disord 2021; 9:42. [PMID: 33789761 PMCID: PMC8010292 DOI: 10.1186/s40337-021-00397-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/17/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Carers of people with eating disorders (EDs) are known to experience a lack of support, high levels of unmet needs and resulting distress. Specific support and interventions for carers may benefit both the carer, and their loved one with an ED. Individuals with co-occurring autism and EDs may present with additional needs and difficulties relating to their Autism Spectrum Condition (ASC) that impact their carers. However, there is a lack of research exploring whether carers of people with ASC and EDs have specific support needs, and what kinds of support may be most beneficial for this population. METHODS This study used a qualitative interview design, utilising peer interviews. Eleven carers participated in interviews about their experiences as a carer, and their views on existing support systems and potential improvements. As the study took place during the initial UK coronavirus lockdown, the impact of the lockdown also emerged as a topic during the interviews. Interviews were transcribed and analysed using thematic analysis. RESULTS Five themes were identified: challenges associated with co-occurring Autism and EDs, a lack of existing support for carers from healthcare services, the personal impact of caring for someone with both ASC and EDs, ideas for how carers can be best supported, and the impact of the coronavirus on carers. CONCLUSIONS Carers of loved ones with both ASC and EDs described the experience as having a significant personal impact on their lives, but also experienced a lack of support from healthcare services. There was a perception that caring for someone with both an ASC and EDs presents additional challenges compared to caring for someone with an ED only, and that this population therefore requires specialised support. Recommendations for possible support options, and for further research, are outlined.
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Affiliation(s)
- Emma Kinnaird
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Madeleine Oakley
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Vanessa Lawrence
- King's College London, Health Services and Population Studies Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Sukhi Shergill
- King's College London, Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK. .,National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, UK.
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Halls D, Leslie M, Leppanen J, Sedgewick F, Surguladze S, Fonville L, Lang K, Simic M, Nicholls D, Williams S, Tchanturia K. The emotional face of anorexia nervosa: The neural correlates of emotional processing. Hum Brain Mapp 2021; 42:3077-3087. [PMID: 33739540 PMCID: PMC8193512 DOI: 10.1002/hbm.25417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN.
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Affiliation(s)
- Daniel Halls
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Psychological Medicine, King's College London (KCL), London, UK
| | - Monica Leslie
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Psychological Medicine, King's College London (KCL), London, UK.,Centre for Contextual Behavioural Science, University of Chester, Chester, UK
| | - Jenni Leppanen
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Felicity Sedgewick
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Psychological Medicine, King's College London (KCL), London, UK.,School of Education, University of Bristol, Bristol, UK
| | - Simon Surguladze
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Psychological Medicine, King's College London (KCL), London, UK
| | - Leon Fonville
- Division of Brain Sciences, Imperial College London, London, UK
| | - Katie Lang
- King's College London (KCL), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dasha Nicholls
- Division of Brain Sciences, Imperial College London, London, UK
| | - Steven Williams
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Psychological Medicine, King's College London (KCL), London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,Psychology Department, Illia State University, Tbilisi, Georgia
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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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Leslie M, Halls D, Leppanen J, Sedgewick F, Smith K, Hayward H, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Murphy D, Williams S, Tchanturia K. Corrigendum: Neural Correlates of Theory of Mind Are Preserved in Young Women With Anorexia Nervosa. Front Psychol 2020; 11:617275. [PMID: 33329289 PMCID: PMC7734186 DOI: 10.3389/fpsyg.2020.617275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Monica Leslie
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,Department of Psychology, University of Chester, Chester, United Kingdom
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Felicity Sedgewick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,School of Education, University of Bristol, Bristol, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Katie Lang
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Leon Fonville
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - William Mandy
- Research Department of Clinical, Health and Educational Psychology, University College London, London, United Kingdom
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, United Kingdom
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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Brede J, Babb C, Jones C, Elliott M, Zanker C, Tchanturia K, Serpell L, Fox J, Mandy W. "For Me, the Anorexia is Just a Symptom, and the Cause is the Autism": Investigating Restrictive Eating Disorders in Autistic Women. J Autism Dev Disord 2020; 50:4280-4296. [PMID: 32274604 PMCID: PMC7677288 DOI: 10.1007/s10803-020-04479-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autistic women are overrepresented among people in treatment for Anorexia Nervosa (AN). The current study aimed to: (1) better understand how AN develops and persists in autistic individuals from the perspective of autistic women, parents and healthcare professionals; (2) derive a theoretical model of restrictive eating difficulties in autism. We conducted 44 semi-structured interviews and used Thematic Analysis to identify patterns of meaning across the data. Themes related to sensory sensitivities, social interaction and relationships, sense of self and identity, difficulties with emotions, thinking styles, and a need for control and predictability. We developed a model of potential autism-specific mechanisms underlying restrictive eating difficulties. This study generated novel insights, which have the potential to inform treatment adaptations following empirical testing.
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Affiliation(s)
- Janina Brede
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Charli Babb
- School of Psychology, Cardiff University, Park Place, Cardiff, CF10 3AT UK
| | - Catherine Jones
- School of Psychology, Cardiff University, Park Place, Cardiff, CF10 3AT UK
| | - Mair Elliott
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | | | | | - Lucy Serpell
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - John Fox
- School of Psychology, Cardiff University, Park Place, Cardiff, CF10 3AT UK
| | - Will Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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Harrison A, Stavri P, Tchanturia K. Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A). Neuropsychiatr 2020; 35:163-176. [PMID: 33252714 DOI: 10.1007/s40211-020-00375-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits. METHODS An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a 10-session individual format delivered to a case series of 12 patients and a 5-session group format delivered to 3 groups of 9 patients. RESULTS Acceptability, measured using a Patient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats. CONCLUSION Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.
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Affiliation(s)
- Amy Harrison
- Department of Psychology and Human Development, University College London, 25 Woburn Square, WC1H 0AA, London, UK.
| | - Pamela Stavri
- Ellern Mede Service for Eating Disorders, Holcombe Hill, The Ridgeway, NW7 4HX, Mill Hill, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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Keeler J, Patsalos O, Thuret S, Ehrlich S, Tchanturia K, Himmerich H, Treasure J. Hippocampal volume, function, and related molecular activity in anorexia nervosa: A scoping review. Expert Rev Clin Pharmacol 2020; 13:1367-1387. [PMID: 33176113 DOI: 10.1080/17512433.2020.1850256] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Anorexia nervosa (AN) is a serious and persistent eating disorder, characterized by severe dietary restriction and weight loss, with a third of patients developing a severe-enduring form. The factors contributing to this progression are poorly understood, although there is evidence for impairments in neural structures such as the hippocampus, an area particularly affected by malnutrition and chronic stress. AREAS COVERED This study aimed to map the evidence for alterations in hippocampal volume, function, and related molecular activity in anorexia nervosa. PubMed, PsycINFO, and Web of Science were searched for studies related to hippocampal function and integrity using a range of methodologies, such as neuropsychological paradigms, structural and functional magnetic resonance imaging, and analysis of blood components. EXPERT OPINION Thirty-nine studies were included in this review. The majority were neuroimaging studies, which found hippocampus-specific volumetric and functional impairments. Neuropsychological studies showed evidence for a specific memory and learning impairments. There was some evidence for molecular abnormalities (e.g. cortisol), although these were few studies. Taken together, our review suggests that the hippocampus might be a particular region of interest when considering neurobiological approaches to understanding AN. These findings warrant further investigation and may lead to novel treatment approaches.
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Affiliation(s)
- Johanna Keeler
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Olivia Patsalos
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, King's College London, Institute of Psychiatry, Psychology and Neuroscience , UK
| | - Stefan Ehrlich
- Faculty of Medicine, Technische Universitat Dresden, Division of Psychological and Social Medicine and Developmental Neurosciences , Germany
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology & Neuroscience ,UK
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Smith KA, Tchanturia K. Are Huddles the Missing PEACE of the Puzzle in Implementing Clinical Innovation for the Eating Disorder and Autism Comorbidity? Front Psychiatry 2020; 11:593720. [PMID: 33250797 PMCID: PMC7674675 DOI: 10.3389/fpsyt.2020.593720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/18/2020] [Indexed: 12/24/2022] Open
Abstract
Huddles are brief, time-limited, focused meetings to help organize and support clinical teams. Huddles have demonstrated their value and transferable benefits across a range of settings. Based on their transferable nature, their potential could be unacknowledged as a clinical implementation technique, particularly in specific subgroups of patients with anorexia who need a higher level of care. An innovative clinical pathway aimed at supporting autistic patients with eating disorders (PEACE Pathway) evaluated the use of weekly PEACE huddles for the multidisciplinary team as part of the implementation process across a 12-months period. A total of 283 responses evaluated the huddle as useful on average 84/100. Using content analysis, several perceived benefits were found of the huddles which were in line with the underpinnings of traditional huddles, suggesting that huddles are transferable as implementation techniques, as evidence by a team providing higher-level care for eating disorders.
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Affiliation(s)
- Katherine Amanda Smith
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust, National Eating Disorder Service, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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Fernández-Aranda F, Munguía L, Mestre-Bach G, Steward T, Etxandi M, Baenas I, Granero R, Sánchez I, Ortega E, Andreu A, Moize VL, Fernández-Real JM, Tinahones FJ, Diegüez C, Frühbeck G, Le Grange D, Tchanturia K, Karwautz A, Zeiler M, Favaro A, Claes L, Luyckx K, Shekriladze I, Serrano-Troncoso E, Rangil T, Meler MEL, Soriano-Pacheco J, Carceller-Sindreu M, Bujalance-Arguijo S, Lozano M, Linares R, Gudiol C, Carratala J, Sanchez-Gonzalez J, Machado PP, Håkansson A, Túry F, Pászthy B, Stein D, Papezová H, Bax B, Borisenkov MF, Popov SV, Kim YR, Nakazato M, Godart N, van Voren R, Ilnytska T, Chen J, Rowlands K, Treasure J, Jiménez-Murcia S. COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study. Eur Eat Disord Rev 2020; 28:871-883. [PMID: 32954595 PMCID: PMC7537123 DOI: 10.1002/erv.2784] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.
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Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Mikel Etxandi
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, School of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Alba Andreu
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Violeta L Moize
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Jose M Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta and Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital and Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Carlos Diegüez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,D. Uznadze Institute of Psychology, Ilia State University, Tbilisi, Georgia
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), Padua, Italy
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Ia Shekriladze
- D. Uznadze Institute of Psychology, Ilia State University, Tbilisi, Georgia
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Teresa Rangil
- Department of Psychiatry, Germans Trias i Pujol University Hospital-IGTP, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Jose Soriano-Pacheco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau e Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain
| | - Mar Carceller-Sindreu
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau e Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain
| | | | | | | | - Carlota Gudiol
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Hospital Universitari Bellvitge, Institut de Investigació Biomedica de Bellvitge (IDIBELL) and Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratala
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Hospital Universitari Bellvitge, Institut de Investigació Biomedica de Bellvitge (IDIBELL) and Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Paulo Pp Machado
- Psychotherapy and Psychopathology Research Unit - Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Gambling Disorder Unit, Malmö Addiction Center, Malmö, Sweden
| | - Ferenc Túry
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Bea Pászthy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.,1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Daniel Stein
- Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hana Papezová
- Department of Psychiatry, 1st Medical Faculty of Charles University, Prague, Czech Republic
| | - Brigita Bax
- Vilnius University Eating Disorders Center, Vilnius, Lithuania
| | - Mikhail F Borisenkov
- Institute of Physiology Komi Science Center UB RAS, Syktyvkar, Russian Federation
| | - Sergey V Popov
- Institute of Physiology Komi Science Center UB RAS, Syktyvkar, Russian Federation
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea
| | - Michiko Nakazato
- International University of Health and Welfare - Psychiatry, Narita, Japan
| | - Nathalie Godart
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Villejuif, France.,Department of Psychiatry, Institut Mutualiste Montsouris, School of Medicine, Université Paris Descartes, Paris, France.,UFR des Sciences de la Santé Simone Veil (UVSQ), Praticienne Hospitalière, Fondation Santé des Etudiants de France, Paris, France
| | | | - Tetiana Ilnytska
- Institute of Psychiatry of Taras Shevchenko, National University of Kyiv, Kyiv, Ukraine
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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45
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Leslie M, Halls D, Leppanen J, Sedgewick F, Smith K, Hayward H, Lang K, Fonville L, Simic M, Mandy W, Nicholls D, Murphy D, Williams S, Tchanturia K. Neural Correlates of Theory of Mind Are Preserved in Young Women With Anorexia Nervosa. Front Psychol 2020; 11:568073. [PMID: 33013605 PMCID: PMC7511528 DOI: 10.3389/fpsyg.2020.568073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
People with anorexia nervosa (AN) commonly exhibit social difficulties, which may be related to problems with understanding the perspectives of others, commonly known as Theory of Mind (ToM) processing. However, there is a dearth of literature investigating the neural basis of these differences in ToM and at what age they emerge. This study aimed to test for differences in the neural correlates of ToM processes in young women with AN, and young women weight-restored (WR) from AN, as compared to healthy control participants (HC). Based on previous findings in AN, we hypothesized that young women with current or prior AN, as compared to HCs, would exhibit a reduced neural response in the medial prefrontal cortex (mPFC), the inferior frontal gyrus, and the temporo-parietal junction (TPJ) whilst completing a ToM task. We recruited 73 young women with AN, 45 WR young women, and 70 young women without a history of AN to take part in the current study. Whilst undergoing a functional magnetic resonance imaging (fMRI) scan, participants completed the Frith-Happé task, which is a commonly used measure of ToM with demonstrated reliability and validity in adult populations. In this task, participants viewed the movements of triangles, which depicted either action movements, simple interactions, or complex social interactions. Viewing trials with more complex social interactions in the Frith-Happé task was associated with increased brain activation in regions including the right TPJ, the bilateral mPFC, the cerebellum, and the dorsolateral prefrontal cortex. There were no group differences in neural activation in response to the ToM contrast. Overall, these results suggest that the neural basis of spontaneous mentalizing is preserved in most young women with AN.
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Affiliation(s)
- Monica Leslie
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,Department of Psychology, University of Chester, Chester, United Kingdom
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Felicity Sedgewick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,School of Education, University of Bristol, Bristol, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Katie Lang
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Leon Fonville
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - William Mandy
- Research Department of Clinical, Health and Educational Psychology, University College London, London, United Kingdom
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, United Kingdom
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, United Kingdom.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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46
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Granero R, Treasure J, Claes L, Favaro A, Jiménez-Murcia S, Karwautz A, Le Grange D, Tchanturia K, Fernández-Aranda F. Null hypothesis significance tests, a misleading approach to scientific knowledge: Some implications for eating disorders research. Eur Eat Disord Rev 2020; 28:483-491. [PMID: 32797731 DOI: 10.1002/erv.2782] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Roser Granero
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Eating Disorders Unit, Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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47
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Bentz M, Westwood H, Jepsen JRM, Plessen KJ, Tchanturia K. The autism diagnostic observation schedule: Patterns in individuals with anorexia nervosa. Eur Eat Disord Rev 2020; 28:571-579. [PMID: 32729156 DOI: 10.1002/erv.2757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/04/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Studies have used the Autism Diagnostic Observation Schedule (the ADOS-2) in individuals with anorexia nervosa (AN), but the patterns of scores have not been assessed. We examined which subset of the ADOS-2 items best discriminate individuals with AN from healthy controls (HC), and assessed the potential clustering of AN participants based on different profiles of the ADOS-2 item scores. METHOD We combined datasets from two previous studies, and (a) compared mean ranks between young AN participants (N = 118) and HC (N = 42), (ii) replicated the item selection procedure of the existing ADOS-2 algorithm to assess sensitivity of items in the AN group, and (c) applied a two-step clustering analysis in the AN group (N = 149). RESULTS AN participants displayed significantly higher mean ranks than HC participants in five of 32 items. All five items are part of the existing ADOS-2 algorithm. We found two clusters of AN participants; one representing normal social behaviour, comprising 68% of the individuals with AN, and one representing less efficient social behaviour, comprising 32% of individuals with AN. CONCLUSIONS The items comprising the social affective cluster of the existing ADOS-2 algorithm are well suited to assess difficulties with social functioning in individuals with AN.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Heather Westwood
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Kate Tchanturia
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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48
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Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Front Psychiatry 2020; 11:722. [PMID: 32793009 PMCID: PMC7393993 DOI: 10.3389/fpsyt.2020.00722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research. METHOD The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review. RESULTS The 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants. CONCLUSIONS CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Cindy Toloza
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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49
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Tchanturia K, Smith K, Glennon D, Burhouse A. Towards an Improved Understanding of the Anorexia Nervosa and Autism Spectrum Comorbidity: PEACE Pathway Implementation. Front Psychiatry 2020; 11:640. [PMID: 32733294 PMCID: PMC7358367 DOI: 10.3389/fpsyt.2020.00640] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
This paper describes an eating disorder service development pilot project helping clinicians implement evidence-based research for patients with anorexia nervosa and autism spectrum condition comorbidity. Currently, there are no clear guidelines or recommendations for people who have the developmental condition of autism spectrum condition and a comorbid eating disorder. The Maudsley eating disorder team is pioneering a tailored approach of adaptations for this autism and eating disorder comorbidity to improve and adapt evidenced-based treatments and improve the experience for patients, families, and clinicians involved in their care. This paper aims to support the clinical and research community to implement some of the learning and new strategies developed through the PEACE pathway. The authors aim is to collaborate with teams nationally and internationally to scale up the project to benefit patients with this comorbidity.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Danielle Glennon
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Burhouse
- Northumbria Healthcare NHS Foundation Trust, Patient Experience Department, Wansbeck General Hospital, Ashington, United Kingdom
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50
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Glashouwer KA, Brockmeyer T, Cardi V, Jansen A, Murray SB, Blechert J, Levinson CA, Schmidt U, Tchanturia K, Wade TD, Svaldi J, Giel KE, Favaro A, Fernández-Aranda F, Friederich HC, Naumann E, Treasure JL, Tuschen-Caffier B, Vocks S, Werthmann J. Time to make a change: A call for more experimental research on key mechanisms in anorexia nervosa. Eur Eat Disord Rev 2020; 28:361-367. [PMID: 32567176 DOI: 10.1002/erv.2754] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
| | - Valentina Cardi
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Jens Blechert
- Centre for Cognitive Neuroscience, Department of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, UK
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Tracey D Wade
- Discipline of Psychology and Orama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Clinic Tübingen, Tübingen, Germany
- Competence Center for Eating Disorders, Tübingen, Germany
| | - Angela Favaro
- Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Hans-Christoph Friederich
- General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Janet L Treasure
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Institute of Psychology, Freiburg, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Jessica Werthmann
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Institute of Psychology, Freiburg, Germany
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