1
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Denning DM, Ciotti V, Gioia A, Viranda T, Reilly EE, Berner LA, Velkoff EA, Anderson LK, Kaye WH, Wierenga CE, Brown TA. Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders. Personal Disord 2024; 15:146-156. [PMID: 37589688 PMCID: PMC10873472 DOI: 10.1037/per0000641] [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] [Indexed: 08/18/2023]
Abstract
Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Dominic M. Denning
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst
| | | | - Ayla Gioia
- Department of Psychology, Hofstra University
| | - Thalia Viranda
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | - Erin E. Reilly
- Department of Psychiatry, University of California San Francisco
| | - Laura A. Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego
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2
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Martinez RG, McNeil GD, Cornacchio D, Schneider BN, Peris TS. A Pilot Project to Integrate Individualized Measurement Into Measurement-Based Care in a Child Partial Hospitalization Program. Behav Ther 2024; 55:191-200. [PMID: 38216232 DOI: 10.1016/j.beth.2023.06.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 01/14/2024]
Abstract
Measurement-based care (MBC), or the regular use of progress measures to inform clinical decision-making, improves quality of care and clinical outcomes. MBC typically focuses on standardized rather than individualized outcome measurement. In this pilot study, we examined the clinical utility of integrating individualized measurement with existing standardized outcome monitoring in a children's partial hospitalization program. Participants were 48 youth (M age 10.13 ± 1.39; 54.2% male, 41.7% female, 4.2% transgender or nonbinary). Comorbidity was common; 83.4% of youth had more than one diagnosis at intake. Using the Youth Top Problems for individualized outcome measurement, we examined Top Problem content and clinical improvement over time. Finally, we examined completion rates and describe implementation issues. Top Problems were heterogeneous and sensitive to change. Of the 144 problems, 107 (74%) had a focus consistent with measures used in program, while 37 (26%) were not captured by standardized measures used in program. Effect sizes from admission to final measurement ranged from Cohen's d = .75 - 1.00. Initial adoption of the MBC was strong, but sustained use of the system over the treatment course was challenging. Individualized outcome measurement in children's partial hospitalization programs is feasible to administer and sensitive to clinical change that is unique from change captured in standardized measures. Parents were able to self-identify clinically meaningful, highly individualized Top Problems. Challenges of implementation and clinical assessment in acute settings and potential strategies for improving implementation are discussed.
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Affiliation(s)
- Ruben G Martinez
- Kaiser Permanente Washington Health Research Institute; UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior
| | - Galen D McNeil
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior
| | | | | | - Tara S Peris
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior.
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3
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Krishnamoorthy G, Shin SM, Rees B. Day Programs for children and adolescents with eating disorders: A systematic review. Eur Eat Disord Rev 2023; 31:199-225. [PMID: 36351879 PMCID: PMC10099450 DOI: 10.1002/erv.2953] [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: 11/29/2021] [Revised: 08/07/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
Day programs have received significant consideration within psychological literature as part of a continuum of mental health services. With increasing attention on the prevalence of eating disorders in children and adolescents, and the need for early intervention to minimize the costs and burden of the disorder, eating disorder day programs (also referred as partial hospitalization) have begun to emerge around the world. Despite their widespread use, no reviews to date have examined the efficacy of day programs for the treatment of eating disorders in children and adolescents. The current narrative literature review aims to describe and evaluate the efficacy of day programs for children and adolescents. The literature review was conducted according to the PRISMA guidelines and aimed to explore the outcomes and common program elements of day programs to guide clinical practice and service development. The review found variations amongst the day programs related to program elements, measures utilized and outcomes. Overall, the results suggest that day programs for children and adolescents are effective at restoring body weight, reducing eating disorder symptoms and addressing comorbid mental health concerns.
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Affiliation(s)
- Govind Krishnamoorthy
- School of Psychology and Wellbeing, Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
| | - So Min Shin
- School of Psychology and Wellbeing, Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Bronwyn Rees
- Young Minds Psychology, Ipswich, Queensland, Australia
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4
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Terrill DR, Levin-Aspenson H, Zimmerman M. Sudden gains and treatment outcomes among depressed individuals in a partial hospitalization programme. Clin Psychol Psychother 2022; 29:1556-1566. [PMID: 35294079 DOI: 10.1002/cpp.2734] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/05/2022]
Abstract
Sudden gains commonly occur among patients receiving psychotherapy for depression and have been found to consistently predict better treatment outcomes. However, the majority of prior research has examined sudden gains primarily in weekly or biweekly treatment settings. Individuals were divided into two groups: those who experienced at least one sudden gain and those who did not. Rates of sudden gain occurrence, pretreatment factors and posttreatment outcomes were examined between the two groups. Over 60% of this sample experienced at least one sudden gain, the majority of which occurred during the first 3 days of treatment. Sudden gains were associated with significantly lower baseline depression and anxiety severity. Patients who experienced sudden gains reported significantly greater improvement in depressive and anxiety symptoms, coping skills, functioning, positive mental health and well-being at treatment termination. This study was conducted in a single location with a relatively homogeneous sample. Due to a lack of follow-up data, we were unable to determine if treatment outcomes were sustained after treatment termination. The assessment timeline of the depressive symptoms differs between baseline and daily scales, which may have affected the number of observed sudden gains after the initial treatment day. The proportion of sudden gains in this study is higher than those found in outpatient settings, demonstrating that this phenomenon may commonly occur among depressed patients in acute treatment. These results suggest that the mechanisms by which sudden gains occur may be reinforced by daily, intensive treatment.
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Affiliation(s)
| | - Holly Levin-Aspenson
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
| | - Mark Zimmerman
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Brown Alpert Medical School, Providence, RI, USA
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5
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Simpson CC, Towne TL, Karam AM, Donahue JM, Hadjeasgari CF, Rockwell R, Kaye WH. Predictors of Stepping Up to Higher Level of Care Among Eating Disorder Patients in a Partial Hospitalization Program. Front Psychol 2021; 12:667868. [PMID: 34366985 PMCID: PMC8336564 DOI: 10.3389/fpsyg.2021.667868] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/11/2021] [Indexed: 11/13/2022] Open
Abstract
Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.
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Affiliation(s)
| | | | | | | | | | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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6
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Forgeard M, Beard C, Shayani D, Silverman AL, Tsukayama E, Björgvinsson T. Predictors of affect following discharge from partial hospitalization: a two-week ecological momentary assessment study. Psychol Med 2021; 51:1157-1165. [PMID: 32008591 PMCID: PMC10150235 DOI: 10.1017/s0033291719004057] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known about the everyday experiences of individuals transitioning from acute to outpatient psychiatric care, an important period of risk for mood symptom relapse. This study used ecological momentary assessment (EMA) to examine whether specific daily experiences were related to momentary affective states following discharge from a partial hospitalization program (PHP). METHODS A sample of 114 adults (Mage = 36 years old, 52% female, 83% White) completed four brief EMA surveys every day for 2 weeks assessing intensity/type of stressful events and social contact, as well as positive/negative affect (PA/NA). Half of participants reported therapeutic skills use. RESULTS Stress severity ratings prospectively predicted increased NA. NA predicted spending less time with close relationships. However, interacting with close relationships predicted increased positive affect (PA). Finally, PA predicted spending time with more people. The use of two skills (behavioral activation and interpersonal effectiveness) was concurrently, but not prospectively, associated with improved affect. CONCLUSIONS Examining daily experiences of individuals discharging from partial hospitalization provides important information about factors that may influence affective states during the transition from acute to outpatient care. Findings from this study can be used to help prepare patients for discharge and develop interventions for the post-acute period.
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Affiliation(s)
- Marie Forgeard
- McLean Hospital
- Harvard Medical School
- William James College
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7
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Tenconi E, Collantoni E, Meregalli V, Bonello E, Zanetti T, Veronese A, Meneguzzo P, Favaro A. Clinical and Cognitive Functioning Changes After Partial Hospitalization in Patients With Anorexia Nervosa. Front Psychiatry 2021; 12:653506. [PMID: 33959056 PMCID: PMC8093567 DOI: 10.3389/fpsyt.2021.653506] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/19/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was to longitudinally assess the impact of partial hospitalization on clinical and cognitive functioning in anorexia nervosa. Materials and Methods: 56 women with anorexia nervosa according to DSM-5 criteria and 58 healthy women were enrolled in the study. At baseline, all participants underwent clinical, diagnostic and neuropsychological assessment (T0). Patients were also assessed at the end of the treatment program (T1; n = 56). Results: BMI improved significantly throughout treatment. At baseline, patients showed significantly poorer executive abilities and less specific autobiographical memory. After the day-hospital program, decision-making abilities improved significantly. Response to treatment was predicted by BMI at admission and duration of illness, but neuropsychological performance did not contribute to the prediction model. Discussion: Cognitive difficulties, mostly regarding executive functions, resulted differently affected by clinical improvement. In particular, while cognitive monitoring and cognitive inhibition appear to be mostly stable trait-like characteristics, decision-making is both more state-dependent and sensitive to clinical status. None of the cognitive variables added information about the response to day hospital treatment; patients with short duration of illness and a rapidly decreasing BMI would benefit more from intensive interventions than less "acute" patients. These observations, if confirmed by future studies, have important clinical implications in order to understand the impact of malnutrition on cognitive functioning and to provide individualized effective treatment for patients with anorexia nervosa.
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Affiliation(s)
- Elena Tenconi
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | | | - Valentina Meregalli
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Elisa Bonello
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Tatiana Zanetti
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Angela Veronese
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
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8
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Dowell KA, Nielsen SJ. Caregiver engagement in youth partial hospitalization treatment. Clin Child Psychol Psychiatry 2021; 26:355-366. [PMID: 33307741 DOI: 10.1177/1359104520978448] [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] [Indexed: 11/17/2022]
Abstract
Although the importance of caregiver engagement in a child's psychological treatment is well established within outpatient treatment settings, the question remains whether these findings can be generalized to more intensive treatment settings where caregiver engagement may be more challenging to facilitate. A correlational, multi-informant design was used to collect data by caregiver self-report and therapist-report from a sample of 64 caregivers of youth referred for partial hospitalization. Results show that caregivers' attitudinal self-assessment of engagement was not significantly related to their self-report of behavioral engagement (e.g. number of family sessions attended) or therapists' report of caregiver engagement. After controlling for caregiver expectations and therapist ratings of caregiver engagement, only caregiver ratings of attendance at family sessions marginally predicted treatment outcomes, but in the negative direction. Implications for adapting measures of caregiver engagement to intensive treatment settings and its impact on treatment outcomes are discussed.
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Affiliation(s)
- Kathy A Dowell
- Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA
| | - Summer J Nielsen
- Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA
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9
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Zanna V, Cinelli G, Criscuolo M, Caramadre AM, Castiglioni MC, Chianello I, Marchili MR, Casamento Tumeo C, Guolo S, Tozzi AE, Vicari S. Corrigendum: Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study. Front Psychiatry 2021; 12:748046. [PMID: 34484012 PMCID: PMC8416163 DOI: 10.3389/fpsyt.2021.748046] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.653482.].
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Affiliation(s)
- Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Chiara Casamento Tumeo
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
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10
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Marzola E, Rienecke RD, Cardi V, Levinson CA. Editorial: Full and Partial Hospitalization Interventions for Eating Disorders. Front Psychiatry 2021; 12:775715. [PMID: 34721121 PMCID: PMC8548463 DOI: 10.3389/fpsyt.2021.775715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/20/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini," Eating Disorders Center, University of Turin, Turin, Italy
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood and Anxiety Centers, Chicago, IL, United States.,Department of Psychiatry and Behavioral Neuroscience, Northwestern University, Chicago, IL, United States
| | - Valentina Cardi
- Department of General Psychology, University of Padova and Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
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11
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Zanna V, Cinelli G, Criscuolo M, Caramadre AM, Castiglioni MC, Chianello I, Marchili MR, Casamento Tumeo C, Guolo S, Tozzi AE, Vicari S. Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study. Front Psychiatry 2021; 12:653482. [PMID: 34122177 PMCID: PMC8192691 DOI: 10.3389/fpsyt.2021.653482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [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: 01/14/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP). Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11-18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups. Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs. Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.
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Affiliation(s)
- Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Giulia Cinelli
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Anna Maria Caramadre
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Ilenia Chianello
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Maria Rosaria Marchili
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Chiara Casamento Tumeo
- General Pediatrics Unit, Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Guolo
- Sanitary Direction, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Alberto Eugenio Tozzi
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Istituto di ricovero e cura a carattere scientifico (IRCCS), Rome, Italy
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12
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Abstract
OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.
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Affiliation(s)
- Lois Rockson
- Lois Rockson, MPH, MAEd, SCT (ASCP), Rutgers University, Newark, NJ, USA
| | - Margaret Swarbrick
- Margaret Swarbrick, PhD, FAOTA, University Behavioral Healthcare, Piscataway, NJ, USA; Collaborative Support Programs of New Jersey, Freehold, NJ, USA
| | - Carlos Pratt
- Carlos Pratt, PhD, CPRP, Rutgers University, Scotch Plains, NJ, USA
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13
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Zickgraf HF, Lane‐Loney S, Essayli JH, Ornstein RM. Further support for diagnostically meaningful ARFID symptom presentations in an adolescent medicine partial hospitalization program. Int J Eat Disord 2019; 52:402-409. [PMID: 30632634 PMCID: PMC7057554 DOI: 10.1002/eat.23016] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 07/30/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify potential presentations of avoidant/restrictive food intake disorder (ARFID) in a pediatric eating disorder partial hospitalization program (PHP) based on the nature of the eating restriction leading to core symptoms of ARFID. METHOD A retrospective chart review of 83 patients ages 8-17 admitted to a PHP and diagnosed with ARFID. Charts were independently reviewed by two coders, with high inter-rater agreement (κ = 0.77). Distinct categories were identified and groups were compared on demographics, anthropometrics, comorbid psychopathology, and core ARFID symptoms. RESULTS We identified cases characterized by predominantly selective eating based on aversions to the sensory properties of foods, lack of interest in eating/low appetite, and fear of aversive consequences from eating. We also distinguished a subset of patients with eating restrictions consistent with both selectivity and limited interest/appetite. The four primary ARFID presentation groups differed on core ARFID criteria, symptom trajectory and illness duration, mood and medical comorbidities, age, gender, and parent-reported symptoms of psychopathology. DISCUSSION The present findings suggest that there are diagnostically meaningful ARFID subtypes that can be differentiated based on the nature of their eating restrictions, as well as other demographic, illness history features, and psychiatric comorbidity. As treatments for youth with ARFID are developed and refined, it will be important to take into consideration not only demographic differences, but also the variability in symptoms, as this might require distinct interventions and levels of care. Additionally, differing mechanisms that maintain different types of eating restrictions might necessitate unique psychological and psychiatric interventions.
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Affiliation(s)
- Hana F. Zickgraf
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's HospitalPenn State College of Medicine Hershey Pennsylvania
| | - Susan Lane‐Loney
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's HospitalPenn State College of Medicine Hershey Pennsylvania
| | - Jamal H. Essayli
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's HospitalPenn State College of Medicine Hershey Pennsylvania
| | - Rollyn M. Ornstein
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's HospitalPenn State College of Medicine Hershey Pennsylvania
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14
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Makhzoumi SH, Schreyer CC, Hansen JL, Laddaran LA, Redgrave GW, Guarda AS. Hospital course of underweight youth with ARFID treated with a meal-based behavioral protocol in an inpatient- partial hospitalization program for eating disorders. Int J Eat Disord 2019; 52:428-434. [PMID: 30779365 DOI: 10.1002/eat.23049] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 07/31/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Information on nutritional rehabilitation for underweight patients with avoidant/restrictive food intake disorder (ARFID) is scarce. This study characterized hospitalized youth with ARFID treated in an inpatient (IP)-partial hospitalization behavioral eating disorders (EDs) program employing an exclusively meal-based rapid refeeding protocol and compared weight restoration outcomes to those of patients with anorexia nervosa (AN). METHOD Data from retrospective chart review of consecutive underweight admissions (N = 275; age 11-26 years) with ARFID (n = 27) were compared to those with AN (n = 248) on clinical features, reason for discharge, and weight restoration variables. For patients with ARFID, presenting phenomenology was further characterized by detailed chart review. RESULTS At admission, 53% of patients with ARFID were vomiting regularly. The predominant ARFID subtype was ARFID-aversive, with close to a third being mixed subtype. Gastrointestinal (GI) symptomatology (81.5%) was the most commonly endorsed reason for restriction. A third had undergone unsuccessful parenteral or enteral tube feeding. Patients with ARFID were more likely male, had higher admission BMI, and slower IP weight gain (1.36 kg /week vs 1.92) compared to patients with AN. Fewer patients with ARFID transitioned to the partial hospitalization program, although the proportion discharged for clinical improvement did not differ and both groups had a mean program discharge BMI >18.5. DISCUSSION GI symptoms appear a common contributor to restrictive eating amongst hospitalized youth with ARFID. Despite a slightly lower rate of IP weight gain, clinical improvement and weight restoration at discharge were similar for patients with ARFID compared to AN.
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Affiliation(s)
- Saniha H Makhzoumi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lori A Laddaran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Bryson AE, Scipioni AM, Essayli JH, Mahoney JR, Ornstein RM. Outcomes of low-weight patients with avoidant/restrictive food intake disorder and anorexia nervosa at long-term follow-up after treatment in a partial hospitalization program for eating disorders. Int J Eat Disord 2018; 51:470-474. [PMID: 29493804 DOI: 10.1002/eat.22853] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 09/26/2017] [Revised: 01/23/2018] [Accepted: 02/12/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess long-term outcomes of patients with avoidant/restrictive food intake disorder (ARFID) treated in a partial hospitalization program (PHP) for eating disorders (ED). METHOD A cross-sectional study comparing patients with ARFID to those with anorexia nervosa (AN) who had been discharged from a PHP for at least 12 months was performed. Percent median body mass index (%MBMI), scores on the Children's Eating Attitudes Test (ChEAT), and treatment utilization were assessed, with intake and discharge data collected via retrospective chart review. RESULTS Of the 137 eligible patients, 62 (45.3%) consented to follow-up data collection. Patients with ARFID and AN exhibited similar increases in %MBMI from intake to discharge and reported low scores on the ChEAT by discharge. Patients with ARFID and AN maintained good weight outcomes and low ChEAT scores at follow-up. Most participants were still receiving outpatient treatment from a variety of providers, although fewer with ARFID than AN continued to receive services from our multidisciplinary ED clinic. DISCUSSION Patients with ARFID and AN exhibit similar improvements in %MBMI when treated in the same PHP and appear to maintain treatment gains at long-term follow-up. Additionally, most patients continue to utilize outpatient services after being discharged from a PHP.
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Affiliation(s)
- Amanda E Bryson
- Penn State College of Medicine, 500 University Drive, Hershey, Pennsylvania, 17033
| | - Anna M Scipioni
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's Hospital, 905 West Governor Road, Suite 250, Hershey, Pennsylvania, 17033
| | - Jamal H Essayli
- Division of Adolescent Medicine and Eating Disorders, Penn State Health Children's Hospital, 905 West Governor Road, Suite 250, Hershey, Pennsylvania, 17033
| | - Johnna R Mahoney
- Penn State College of Medicine, 500 University Drive, Hershey, Pennsylvania, 17033
| | - Rollyn M Ornstein
- Penn State College of Medicine, 500 University Drive, Hershey, Pennsylvania, 17033
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16
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Guarda AS, Schreyer CC, Fischer LK, Hansen JL, Coughlin JW, Kaminsky MJ, Attia E, Redgrave GW. Intensive treatment for adults with anorexia nervosa: The cost of weight restoration. Int J Eat Disord 2017; 50:302-306. [PMID: 28130794 DOI: 10.1002/eat.22668] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Weight restoration in anorexia nervosa (AN) is associated with lower relapse risk; however rate of weight gain and percent of patients achieving weight restoration (BMI ≥ 19 at discharge) vary among treatment programs. We compared both cost/pound of weight gained and cost of weight restoration in a hospital-based inpatient (IP)-partial hospitalization (PH) eating disorders program to estimates of these costs for residential treatment. METHOD All adult first admissions to the IP-PH program with AN (N = 314) from 2003 to 2015 were included. Cost of care was based on hospital charges, rates of weight gain, and weight restoration data. Results were compared with residential treatment costs extracted from a national insurance claims database and published weight gain data. RESULTS Average charge/day in the IP-PH program was $2295 for IP and $1567 for PH, yielding an average cost/pound gained of $4089 and $7050, respectively, with 70% of patients achieving weight restoration. Based on published mean weight gain data and conservative cost/day estimates, residential treatment is associated with higher cost/pound, and both higher cost and lower likelihood of weight restoration for most patients. DISCUSSION The key metrics used in this study are recommended for comparing the cost-effectiveness of intensive treatment programs for patients with AN.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York.,Department of Psychiatry, Weill Cornell Medical College, New York
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
OBJECTIVES This program evaluation reviewed the outcomes of a new 10-week multi-modal mental health day treatment program for elderly clients with mood and anxiety disorders. METHODS A retrospective chart review of clients admitted during the first 3 years of the program (N = 255) was conducted. Paired sample t-tests were used to compare admission and discharge data. Focus groups were run with clients who attended the program during the previous months, to delineate the strengths of the program and to identify areas for improvement. RESULTS Analyses showed statistically and clinically significant improvements in client symptomatology, as evidenced by reductions on the Geriatric Depression Scale and the Clinical Outcomes in Routine Evaluation Outcome Measure in clients who completed the program. Focus group participants overwhelmingly described the program as very beneficial, but the desire for on-going follow-up was clearly articulated. CONCLUSIONS A practice model employing group-based cognitive-behavioural and interpersonal strategies that emphasizes behavioral activation and socialization is associated with a reduction in depressive symptoms and psychological distress in a large sample of elderly adults in a day treatment service with mild to moderate symptoms of depression and anxiety. CLINICAL IMPLICATIONS In the future, a mechanism for on-going mental health support should be included. Many clients want to remain connected to the system, but there is not always a clear path along the continuum of care, particularly for clients who no longer meet criteria for a psychiatric disorder.
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