Web-Based Aftercare for Women With Bulimia Nervosa Following Inpatient Treatment: Randomized Controlled Efficacy Trial

Background

Relapse rates in bulimia nervosa (BN) are high even after successful treatment, but patients often hesitate to take up further treatment. An easily accessible program might help maintain treatment gains. Encouraged by the effects of Web-based eating disorder prevention programs, we developed a manualized, Web-based aftercare program (IN@) for women with BN following inpatient treatment.

Objective

The objective of this study was to determine the efficacy of the web-based guided, 9-month, cognitive-behavioral aftercare program IN@ for women with BN following inpatient treatment.

Methods

We conducted a randomized controlled efficacy trial in 253 women with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) BN and compared the results of IN@ with treatment as usual (TAU). Assessments were carried out at hospital admission (T0), hospital discharge/baseline (T1), postintervention (T2; 9 months after baseline), 9-month follow-up (T3; 18 months after baseline). The primary outcome, abstinence from binge eating and compensatory behaviors during the 2 months preceding T2, was analyzed by intention to treat, using logistic regression analyses. Frequencies of binge eating and vomiting episodes, and episodes of all compensatory behaviors were analyzed using mixed effects models.

Results

At T2, data from 167 women were available. There were no significant differences in abstinence rates between the TAU group (n=24, 18.9%) and the IN@ group (n=27, 21.4%; odds ratio, OR=1.29; P=.44). The frequency of vomiting episodes in the IN@ group was significantly (46%) lower than in the TAU group (P=.003). Moderator analyses revealed that both at T2 and T3, women of the intervention group who still reported binge eating and compensatory behaviors after inpatient treatment benefited from IN@, whereas women who were already abstinent after the inpatient treatment did not (P=.004; P=.002). Additional treatment utilization was high in both groups between baseline and follow-up.

Conclusions

Overall, data from this study suggest moderate effects of IN@. High rates of outpatient treatment utilization after inpatient treatment may have obscured potential intervention effects on abstinence. An aftercare intervention might be more beneficial as part of a stepped-care approach.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 08870215; http://www.isrctn.com/ISRCTN08870215 (Archived by WebCite at http://www.webcitation.org/6soA5bIit)

Effects of perceptual body image distortion and early weight gain on long-term outcome of adolescent anorexia nervosa

Anorexia nervosa (AN), a severe mental disorder with an onset during adolescence, has been found to be difficult to treat. Identifying variables that predict long-term outcome may help to develop better treatment strategies. Since body image distortion and weight gain are central elements of diagnosis and treatment of AN, the current study investigated perceptual body image distortion, defined as the accuracy of evaluating one's own perceived body size in relation to the actual body size, as well as total and early weight gain during inpatient treatment as predictors for long-term outcome in a sample of 76 female adolescent AN patients. Long-term outcome was defined by physical, psychological and psychosocial adjustment using the Morgan-Russell outcome assessment schedule as well as by the mere physical outcome consisting of menses and/or BMI approximately 3 years after treatment. Perceptual body image distortion and early weight gain predicted long-term outcome (explained variance 13.3 %), but not the physical outcome alone. This study provides first evidence for an association of perceptual body image distortion with long-term outcome of adolescent anorexia nervosa and underlines the importance of sufficient early weight gain.

[Practical implementation of an integrated care model in mother-child treatment]

This article summarizes the specific treatment options in the combined mother-child treatment for women with postpartum psychiatric disorders. The incidence of postpartum mental illness is high, especially for postpartum depression that probably occurs in10-15 % of cases. Mental disorders not only have a negative impact on the mental health of the women affected, such as chronification and suicidal tendencies but can also adversely affect the mother-child relationship as well as the emotional and cognitive development of the child. For these reasons it is important, also under the aspects of a primary prevention with respect to the children of mentally ill mothers, to provide a needs-oriented, timely and disorder-specific interactional therapy, which also considers the long-term aspects of treatment. At the Celenus Klinik Carolabad in Chemnitz an integrated treatment model, the "Carola PLUS", could be established that caters for the particularly high demands of combined care and treatment for both mother and child.

Diagnosing underweight in adolescent girls: should we rely on self-reported height and weight?

This study examines the reliability of self-reported height, weight and weight change in underweight versus normal weight adolescent females. Self-reported height and weight were obtained from 162 schoolgirls without an eating disorder (12-16 years), and compared to objective measurements afterwards. Weight change was assessed 4 months later. The influence of age and current BMI on the reliability of self-reports was analyzed by linear regression analyses. With increasing age, height and BMI were reported more accurately. With increasing BMI, the underestimation of weight increased. Underweight girls overestimated their weight significantly compared to normal weight girls. Only 41% of the girls with a weight loss (>1 kg) in the past 4 months reported this accurately. Therefore, especially in younger girls with low body weight, information on height and weight as well as weight changes should be obtained objectively to identify a developing or subthreshold anorexia nervosa.

Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample

BACKGROUND

Numerous longitudinal studies have identified risk factors for the onset of most eating disorders (EDs). Identifying women at highest risk within a high-risk sample would allow for focusing of preventive resources and also suggests different etiologies.

METHOD

A longitudinal cohort study over 3 years in a high-risk sample of 236 college-age women randomized to the control group of a prevention trial for EDs. Potential risk factors and interactions between risk factors were assessed using the methods developed previously. Main outcome measures were time to onset of a subthreshold or full ED.

RESULTS

At the 3-year follow-up, 11.2% of participants had developed a full or partial ED. Seven of 88 potential risk factors could be classified as independent risk factors, seven as proxies, and two as overlapping factors. Critical comments about eating from teacher/coach/siblings and a history of depression were the most potent risk factors. The incidence for participants with either or both of these risk factors was 34.8% (16/46) compared to 4.2% (6/144) for participants without these risk factors, with a sensitivity of 0.75 and a specificity of 0.82.

CONCLUSIONS

Targeting preventive interventions at women with high weight and shape concerns, a history of critical comments about eating weight and shape, and a history of depression may reduce the risk for EDs.

Psychologische Intervention im Rahmen einer allogenen Knochenmarktransplantation

Zusammenfassung. Allogene Knochenmarktransplantationen (KMT) haben sich in den letzten Jahren zu einem anerkannten Verfahren zur Behandlung von Krebserkrankungen entwickelt. Obwohl der Einfluss psychologischer Faktoren auf Erleben und Überleben einer KMT immer stärker Beachtung findet, existiert zum jetzigen Zeitpunkt keine Arbeit, die systematisch die Wirkung standardisierter psychologischer Betreuung in diesem Zusammenhang untersucht. Anhand von 20 Patienten überprüft die vorliegende Studie in einem randomisierten kontrollierten Versuchsdesign die Eignung eines psychologischen Interventionsprogramms zur Senkung der subjektiven Wahrnehmung körperlicher Beschwerden im Rahmen einer KMT. Die Ergebnisse sprechen für die Wirksamkeit des Interventionsprogramms: Patienten in der Interventionsgruppe berichteten weniger körperliche Beschwerden als Patienten in der Kontrollbedingung, wobei die Effektstärken als klein bis mittel einzuordnen sind. Die Ergebnisse werden hinsichtlich des möglichen zukünftigen Einsatzes des Interventionsprogramms diskutiert.