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Steinglass JE, Fei W, Foerde K, Touzeau C, Ruggiero J, Lloyd C, Attia E, Wang Y, Walsh BT. Change in food choice during acute treatment and the effect on longer-term outcome in patients with anorexia nervosa. Psychol Med 2024; 54:1133-1141. [PMID: 37781904 DOI: 10.1017/s0033291723002933] [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] [Indexed: 10/03/2023]
Abstract
BACKGROUND Restriction of food intake is a central pathological feature of anorexia nervosa (AN). Maladaptive eating behavior and, specifically, limited intake of calorie-dense foods are resistant to change and contribute to poor long-term outcomes. This study is a preliminary examination of whether change in food choices during inpatient treatment is related to longer-term clinical course. METHODS Individuals with AN completed a computerized Food Choice Task at the beginning and end of inpatient treatment to determine changes in high-fat and self-controlled food choices. Linear regression and longitudinal analyses tested whether change in task behavior predicted short-term outcome (body mass index [BMI] at discharge) and longer-term outcome (BMI and eating disorder psychopathology). RESULTS Among 88 patients with AN, BMI improved significantly with hospital treatment (p < 0.001), but Food Choice Task outcomes did not change significantly. Change in high-fat and self-controlled choices was not associated with BMI at discharge (r = 0.13, p = 0.22 and r = 0.10, p = 0.39, respectively). An increase in the proportion of high-fat foods selected (β = 0.91, p = 0.02) and a decrease in the use of self-control (β = -1.50, p = 0.001) predicted less decline in BMI over 3 years after discharge. CONCLUSIONS Short-term treatment is associated with improvement in BMI but with no significant change, on average, in choices made in a task known to predict actual eating. However, the degree to which individuals increased high-fat choices during treatment and decreased the use of self-control over food choice were associated with reduced weight loss over the following 3 years, underscoring the need to focus on changing eating behavior in treatment of AN.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Wenbo Fei
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Karin Foerde
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Touzeau
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Julia Ruggiero
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caitlin Lloyd
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
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Vanzhula I, Hagan K, Duck SA, Pan I, Wang EY, Steinglass J, Attia E, Wildes JE, Guarda AS, Schreyer C. Eating disorder symptom non-endorsers in hospitalised patients with anorexia nervosa: Who are they? Eur Eat Disord Rev 2024. [PMID: 38528330 DOI: 10.1002/erv.3087] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE Impaired insight and illness denial are common in anorexia nervosa (AN). Missing an AN diagnosis may delay treatment and negatively impact outcomes. METHOD The current retrospective study examined the prevalence and characteristics of AN symptom non-endorsement (i.e., scoring within the normal range on the Eating Disorder Examination Questionnaire [EDE-Q] or the Eating Disorder Examination [EDE] interview) in three independent samples of hospitalised patients with AN (N1 = 154; N2 = 300; N3 = 194). A qualitative chart review of a subsample of non-endorsers (N4 = 32) extracted reports of disordered eating behaviours observed by the treatment team. RESULTS The prevalence of non-endorsement ranged from 11% to 34% across sites. Non-endorsers were more likely to be diagnosed with AN restricting type (AN-R) and reported fewer symptoms of co-occurring psychopathology than endorsers. Groups benefitted equally from treatment. The qualitative chart review indicated that objective symptoms of AN were recorded by staff in over 90% of non-endorsers. CONCLUSIONS Eating disorder symptom assessments using the EDE-Q or EDE may miss symptomatology in up to a third of individuals hospitalised with AN. This study highlights the potential utility of multi-modal assessment including patient interviews, collateral informants, and behavioural observation to circumvent non-endorsement.
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Affiliation(s)
- Irina Vanzhula
- University of Kansas, LifeSpan Institute, Lawrence, Kansas, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelsey Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Sarah Ann Duck
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Isabella Pan
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erin Y Wang
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia, New York, USA
| | - Jennifer E Wildes
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago Medicine, Chicago, Illinois, USA
| | - Angela S Guarda
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen Schreyer
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Muratore AF, Foerde K, Lloyd EC, Touzeau C, Uniacke B, Aw N, Semanek D, Wang Y, Walsh BT, Attia E, Posner J, Steinglass JE. Reduced dorsal fronto-striatal connectivity at rest in anorexia nervosa. Psychol Med 2024:1-10. [PMID: 38497102 DOI: 10.1017/s003329172400031x] [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] [Indexed: 03/19/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious psychiatric illness that remains difficult to treat. Elucidating the neural mechanisms of AN is necessary to identify novel treatment targets and improve outcomes. A growing body of literature points to a role for dorsal fronto-striatal circuitry in the pathophysiology of AN, with increasing evidence of abnormal task-based fMRI activation within this network among patients with AN. Whether these abnormalities are present at rest and reflect fundamental differences in brain organization is unclear. METHODS The current study combined resting-state fMRI data from patients with AN (n = 89) and healthy controls (HC; n = 92) across four studies, removing site effects using ComBat harmonization. First, the a priori hypothesis that dorsal fronto-striatal connectivity strength - specifically between the anterior caudate and dlPFC - differed between patients and HC was tested using seed-based functional connectivity analysis with small-volume correction. To assess specificity of effects, exploratory analyses examined anterior caudate whole-brain connectivity, amplitude of low-frequency fluctuations (ALFF), and node centrality. RESULTS Compared to HC, patients showed significantly reduced right, but not left, anterior caudate-dlPFC connectivity (p = 0.002) in small-volume corrected analyses. Whole-brain analyses also identified reduced connectivity between the right anterior caudate and left superior frontal and middle frontal gyri (p = 0.028) and increased connectivity between the right anterior caudate and right occipital cortex (p = 0.038). No group differences were found in analyses of anterior caudate ALFF and node centrality. CONCLUSIONS Decreased coupling of dorsal fronto-striatal regions indicates that circuit-based abnormalities persist at rest and suggests this network may be a potential treatment target.
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Affiliation(s)
- Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Karin Foerde
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - E Caitlin Lloyd
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Touzeau
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Natalie Aw
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - David Semanek
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Yun Wang
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
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4
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Harris A, Mannan H, Hay P, Aouad P, Arcelus J, Attia E, Crosby R, Madden S, Meyer C, Touyz S. Assessment and treatment of compulsive exercise in anorexia nervosa - A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales. Eat Behav 2024; 52:101825. [PMID: 38006774 DOI: 10.1016/j.eatbeh.2023.101825] [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: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Compulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated. METHOD This study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology. RESULTS LEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology. CONCLUSION The results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.
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Affiliation(s)
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University; Mental Health Services, SWSLHD, Campbellown, Australia.
| | - Phillip Aouad
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA; Weill Cornell Medical College, New York, USA.
| | - Ross Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
| | - Sloane Madden
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK.
| | - Stephen Touyz
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
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5
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Owens RA, Houchins J, Nolan S, Smalling MM, Attia E, Fitzpatrick JJ. Feasibility of a 3-Minute Mindful Breathing Intervention for Enhancing Psychiatric Mental Health Nurses' Resilience During COVID: Findings From a 4-Week Pilot Study. Holist Nurs Pract 2024; 38:E1-E9. [PMID: 37966993 DOI: 10.1097/hnp.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
COVID created a perfect storm of conditions leading to excessive and prolonged stress on already vulnerable nurses. This study examines the feasibility of enhancing psychiatric mental health nurses' (PMHNs') resilience by practicing a 3-minute mindfulness-based intervention. In this pilot study, we explored if PMHNs could be recruited and retained for intervention implementation, intervention acceptability, and measurement of any notable changes over the prescribed period. Study feasibility is reflected in high participant retention and increased postintervention resilience scores. Given the positive outcomes, a larger-scale study is warranted. Additional areas of opportunity include strategies for increasing participant uptake, and, due to limited acceptability feedback, the introduction of a usefulness scale.
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Affiliation(s)
- Rebecca A Owens
- New York State Psychiatric Institute, New York (Drs Owens and Attia); Columbia University School of Nursing, New York, New York (Dr Houchins); Providence, Los Angeles, California (Dr Nolan); New York State Office of Mental health, Albany (Ms Smalling); and Case Western Reserve University, Cleveland, Ohio (Dr Fitzpatrick)
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6
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Glasofer DR, Lemly DC, Lloyd C, Jablonski M, Schaefer LM, Wonderlich SA, Attia E. Evaluation of an online modular eating disorders training (PreparED) to prepare healthcare trainees: a survey study. BMC Med Educ 2023; 23:868. [PMID: 37974188 PMCID: PMC10652638 DOI: 10.1186/s12909-023-04866-1] [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] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Eating disorders (EDs) are serious, complex disorders for which broad-based clinical training is lacking. This study aimed to evaluate the efficacy of a free, brief, web-based curriculum, PreparED, in increasing comfort and confidence with, and knowledge about EDs in healthcare trainees, and to obtain program feedback from key stakeholders (i.e., learners). METHODS This programmatic evaluation study was designed as a quantitative, repeated measures (i.e., pre- and post-test intervention) investigation. A convenience sample of two groups of healthcare trainees across geographically diverse training sites completed an anonymous survey pre- and post- engagement with PreparED. The survey included items to assess prior exposure to EDs, as well as program feasibility. The main educational outcomes included (1) Confidence and Comfort with EDs and (2) Knowledge of EDs. User experience variables of interest were likeability, usability, and engagement with the training modules. Mixed effects linear regression was used to assess the association between PreparED and educational outcome variables. RESULTS Participants (N = 67) included 41 nutrition graduate students and 26 nurse practitioner students recruited from Teacher's College/Columbia University in New York, NY, USA, Columbia University School of Nursing in New York, NY, USA and North Dakota State University School of Nursing in Fargo, ND, USA. Confidence/Comfort scores and Knowledge scores significantly improved following engagement with PreparED (β = for effect of intervention = 1.23, p < 0.001, and 1.69, p < 0.001, respectively). Neither training group nor prior exposure to EDs moderated the effect on outcomes. All learners agreed the program was easy to follow; the overwhelming majority (89.4%) felt the length of the modules was "just right." All participants perceived that PreparED had increased their knowledge of EDs, and the majority (94.0%) reported greater confidence in and comfort with caring for people with these disorders, including assessment of symptoms, awareness of associated medical complications, and likelihood of future screening. CONCLUSIONS Findings suggest that brief, user-friendly, online courses can improve knowledge and attitudes about EDs, filling a critical gap in healthcare training.
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Affiliation(s)
- Deborah R Glasofer
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA.
| | - Diana C Lemly
- Massachusetts General Hospital, Harvard University School of Medicine, Boston, USA
| | - Caitlin Lloyd
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
| | - Monica Jablonski
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
| | - Lauren M Schaefer
- Center for Biobehavioral Research, Sanford Research, Fargo, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, Fargo, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
- Weill Cornell Medical College, New York, USA
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Attia E, Steinglass JE. Psilocybin for anorexia nervosa: If it helps, let's learn how. Med 2023; 4:581-582. [PMID: 37689054 DOI: 10.1016/j.medj.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
Existing treatments for adults with anorexia nervosa (AN) have limited effectiveness. AN is a brain-based disorder with behavioral and cognitive features leading to severe undernourishment. Peck et al. conducted a small open trial suggesting safety and tolerability of psilocybin for AN,1 opening an avenue for further investigation into the neural mechanisms involved.
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Affiliation(s)
- Evelyn Attia
- NYS Psychiatric Institute/Columbia University Irving Medical Center, New York City, NY, USA; Weill Cornell Medical College, New York City, NY, USA.
| | - Joanna E Steinglass
- NYS Psychiatric Institute/Columbia University Irving Medical Center, New York City, NY, USA
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8
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Steinglass J, Attia E. The next stages of treatment-oriented research: Commentary on Wade et al. (2023). Int J Eat Disord 2023. [PMID: 37578290 DOI: 10.1002/eat.24047] [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: 07/27/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
Treatments for eating disorders have established benefits; yet, current psychotherapies focus specifically on the cognitions and behaviors of the eating disorder. Wade et al. (2023) propose that the myriad symptoms and disorders that occur together with eating disorders merit specific attention in treatment research protocols. We seek to amplify the authors' call to take a fresh look at the characterization of eating disorders, and the need for treatment research to consider both the role of symptoms that occur as part and parcel of an eating disorder (such as mood, anxiety, and obsessionality) and the role of co-occurring disorders (such as obsessive-compulsive disorder and substance use disorders). We discuss additional aspects in the care of patients with eating disorders that were beyond the scope of Wade et al., such as the impact of systems of care, and consideration of medication trials. We propose that current research priorities (mechanism-based treatment development, transdiagnostic symptoms, and patient perspectives) can be leveraged to advance treatment research and develop a systematic approach to evaluation and treatment planning.
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Affiliation(s)
- Joanna Steinglass
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, New York, USA
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Hay P, Mohsin M, Liu L, Touyz S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Conti J. Impact of LEAP and CBT-AN Therapy on Improving Outcomes in Women with Anorexia Nervosa. Behav Sci (Basel) 2023; 13:651. [PMID: 37622791 PMCID: PMC10451721 DOI: 10.3390/bs13080651] [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: 05/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Anorexia nervosa (AN) is a mental health disorder that has serious physical, emotional and social consequences. Whilst cognitive behavioural therapy for AN (CBT-AN) has demonstrated efficacy, there remains a global need to improve AN treatment. Compulsive exercise activity therapy (LEAP) is an active therapy consisting of the addition to CBT-AN of eight specific sessions that focus on exercise and motivation for behavioural change. This paper presents a secondary analysis of 74 female participants in a randomised control trial of LEAP plus CBT-AN versus CBT-AN alone. The main aim of this study was to explore putative predictors and to estimate the magnitude of changes due to LEAP for specific outcome measures. Participants (LEAP: n = 36; CBT-AN: n = 38) were assessed at three successive surveys: baseline, end of therapy, and 6 months post-therapy. The overall effect sizes for changes between baseline to end of therapy and baseline to 6-month follow-up assessment showed large effect sizes (Cohen's d > = 0.80) for mental-health-related quality of life (MHRQoL), weight concern, dietary restraint, eating concern, AN stage change, and psychological distress (all p < 0.05). The results also indicated that several pre-treatment characteristics, including body mass index (BMI), level of eating disorder (ED) symptoms, and MHRQoL are important for identifying whether a treatment is likely to be effective. Future treatment programs should aim to optimise early improvements in BMI, ED symptoms, and MHRQoL.
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Affiliation(s)
- Phillipa Hay
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Mohammed Mohsin
- Mental Health Research Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW Health, Liverpool, NSW 2170, Australia
- Faculty of Medicine & Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Liquan Liu
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW 2560, Australia
| | - Stephen Touyz
- Inside Out Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, University of Barcelona, 08908 Barcelona, Spain
| | - Sloane Madden
- The Sydney Children’s Hospitals Network, Westmead, Sydney, NSW 2145, Australia
| | - Evelyn Attia
- The New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Kathleen M. Pike
- World Health Organization Collaborating Centre for Capacity Building and Training in Global Mental Health, Columbia University Medical Center, New York, NY 10032, USA
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- School of Psychology, Western Sydney University, Sydney, NSW 2560, Australia
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10
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Pagano N, Glasofer DR, Attia E, Ruggiero J, Eziri K, Goldstein CM, Steinglass JE. Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study. Int J Eat Disord 2023; 56:1417-1431. [PMID: 37051854 PMCID: PMC10524497 DOI: 10.1002/eat.23952] [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: 12/23/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+). METHODS Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics. RESULTS Transcript analysis yielded three topics related to relapse prevention: (1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and (3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content. DISCUSSION Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments. PUBLIC SIGNIFICANCE Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.
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Affiliation(s)
- Nikki Pagano
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York,
USA
| | - Julia Ruggiero
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Kelechi Eziri
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam
Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
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Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, Golden N, Guarda A, Jackson-Triche M, Manzo L, Mascolo M, Pierce K, Riddle M, Seritan A, Uniacke B, Zucker N, Yager J, Craig TJ, Hong SH, Medicus J. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry 2023; 180:167-171. [PMID: 36722117 DOI: 10.1176/appi.ajp.23180001] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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12
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Shear M, Belak L, Kerrigan S, Smith-Roberts D, Attia E. The impact of open versus closed weighing on rate of weight gain and length of stay among inpatients with anorexia nervosa. Eat Disord 2022; 31:151-160. [PMID: 35671248 DOI: 10.1080/10640266.2022.2086721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Anorexia nervosa (AN) is a serious illness associated with significant morbidity and mortality. Few data exist to guide practice regarding sharing daily weight information (open weighing) or withholding it (closed weighing) from patients. We investigated the effect of open versus closed weighing on weight-related outcomes among inpatients with AN. Data were collected during a 4-month period when 43 patients were not told their daily weight, and a consecutive 4-month period when 41 patients were told their weights during rounds. There was no significant difference in mean overall weight change (3.6 ± 2.7 kg vs. 3.5 ± 2.5 kg), hospital duration (14.3 ± 10.0 vs. 14.2 ± 7.6 days), or rate of weight gain (0.26 ± 0.11 vs. 0.25 ± 0.13 kg) between groups. It is possible that one weighing procedure may not be preferable with respect to certain clinical outcomes for inpatients with AN, suggesting there may be multiple ways to navigate the discussion of weight progress in weight restoration programs.
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Affiliation(s)
- Matthew Shear
- Department of Psychiatry, Weill Cornell Medical College New York-Presbyterian Hospital, New York, New York, USA
| | - Lauren Belak
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sean Kerrigan
- Dell Medical School, Dell Children's Medical Center, Austin, Texas, USA
| | - Diahann Smith-Roberts
- Department of Psychiatry, Weill Cornell Medical College New York-Presbyterian Hospital, New York, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Weill Cornell Medical College New York-Presbyterian Hospital, New York, New York, USA.,Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
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13
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Steinglass JE, Attia E, Glasofer DR, Wang Y, Ruggiero J, Walsh BT, Thomas JG. Optimizing relapse prevention and changing habits (REACH+) in anorexia nervosa. Int J Eat Disord 2022; 55:851-857. [PMID: 35488866 PMCID: PMC9167790 DOI: 10.1002/eat.23724] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Relapse rates in anorexia nervosa (AN) are high, even after full weight restoration. This study aims to develop a relapse prevention treatment that specifically addresses persistent maladaptive behaviors (habits). Relapse Prevention and Changing Habits (REACH+) aims to support patients in developing routines that promote weight maintenance, encourage health, and challenge habits that perpetuate illness. The clinical trial design uses the Multiphase Optimization STrategy (MOST) framework to efficiently identify which components of treatment contribute to positive outcomes. METHODS Participants will be 60 adults with AN who have achieved weight restoration in an inpatient setting. Treatment will consist of 6 months of outpatient telehealth sessions. REACH+ consists of behavior, cognitive, and motivation components, as well as food monitoring and a skill consolidation phase. A specialized online platform extends therapy between sessions. Participants will be randomly assigned to different versions of each component in a fractional factorial design. Outcomes will focus on maintenance of remission, measured by rate of weight loss and end-of-trial status. Interventions that contribute to remission will be included in an optimized treatment package, suitable for a large-scale clinical trial of relapse prevention in AN.
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Affiliation(s)
- Joanna E. Steinglass
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Yuanjia Wang
- Columbia University Irving Medical Center, New York, New York, USA
| | - Julia Ruggiero
- Columbia University Irving Medical Center, New York, New York, USA
| | - B. Timothy Walsh
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
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14
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Affiliation(s)
- Evelyn Attia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Psychiatry, Weill Cornell Medicine, New York, New York
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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15
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Muratore AF, Bershad M, Steinglass JE, Foerde KE, Gianini L, Broft A, Attia E. Use of high-frequency repetitive transcranial magnetic stimulation to probe the neural circuitry of food choice in anorexia nervosa: A proof-of-concept study. Int J Eat Disord 2021; 54:2031-2036. [PMID: 34415081 PMCID: PMC9126092 DOI: 10.1002/eat.23597] [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: 05/20/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/07/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is used to modulate neural systems and provides the opportunity for experimental tests of hypotheses regarding mechanisms underlying anorexia nervosa (AN). The present pilot study has investigated whether high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to a region of the right dorsolateral prefrontal cortex (DLPFC) might be associated with change in food selection among adult inpatients with AN. Ten women received one session of sham and one session of HF-rTMS targeting the right DLPFC while completing a computerized Food Choice Task. Compared to sham, HF-rTMS was associated with changes in food ratings and food choice: inpatients reported higher healthiness ratings of low- and high-fat foods and selected a significantly greater proportion of high-fat foods over a neutrally rated reference item while receiving HF-rTMS. Findings suggest that HF-rTMS to the right DLPFC was associated with a reduction of fat avoidance on a food choice task among inpatients with AN and provide additional support for the possibility that this region, and related neural circuits, may underlie restrictive food choice. Research using rTMS to experimentally test neural mechanisms is needed to elucidate the underpinnings of AN and supports the development of novel treatment targets.
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Affiliation(s)
- Alexandra F. Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Mariya Bershad
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Karin E. Foerde
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Loren Gianini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Allegra Broft
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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16
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Abstract
OBJECTIVE There is long-standing interest in how best to define stages of illness for anorexia nervosa, including remission and recovery. The authors used data from a previously published study to examine the time course of relapse over the year following full weight restoration. METHODS Following weight restoration in an acute care setting, 93 women with anorexia nervosa were randomly assigned to receive fluoxetine or placebo and were discharged to outpatient care, where they also received cognitive-behavioral therapy for up to 1 year. Relapse was defined on the basis of a priori clinical criteria. Fluoxetine had no impact on the time to relapse. In the present analysis, for each day after entry into the study, the risk of relapse over the following 60 days and the following 90 days was calculated and a parametric function was fitted to approximate the Kaplan-Meier estimator. RESULTS The risk of relapse rose immediately after entry into the study, reached a peak after approximately 60 days, and then gradually declined. There was no indication of an inflection point at which the risk of relapse fell precipitously after the initial peak. CONCLUSIONS This analysis highlights the fact that adult patients with anorexia nervosa are at increased risk of relapse in the first months following discharge from acute care, suggesting a need for frequent follow-up and relapse prevention-focused treatment during this period. After approximately 2 months, the risk of relapse progressively decreases over time.
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Affiliation(s)
- B. Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Tianchen Xu
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Yuanjia Wang
- New York State Psychiatric Institute, New York, New York,Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,New York State Psychiatric Institute, New York, New York
| | - Allan S. Kaplan
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Bailey-Straebler S, Redlak-Olcese A, Attia E. Eating disorder treatment in very old age: A case for using CBT. Int J Geriatr Psychiatry 2021; 37. [PMID: 34453854 DOI: 10.1002/gps.5618] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Suzanne Bailey-Straebler
- Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, New York, USA
- Columbia University Medical Center, New York, New York, USA
| | | | - Evelyn Attia
- Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, New York, USA
- Columbia University Medical Center, New York, New York, USA
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18
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Owens RA, Attia E, Fitzpatrick JJ, Phillips K, Nolan S. Eating Disorders: Identification and Management in General Medical and Psychiatric Settings. J Am Psychiatr Nurses Assoc 2021; 29:241-251. [PMID: 33736519 DOI: 10.1177/1078390321999713] [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: 11/16/2022]
Abstract
OBJECTIVE Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.
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Affiliation(s)
- Rebecca A Owens
- Rebecca A. Owens, DNP, MBA, MSN, RN-BC, New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Evelyn Attia, MD, New-YorkPresbyterian/ Columbia University Irving Medical Center; Clinical Director, New York State Psychiatric Institute, New York, NY, USA
| | - Joyce J Fitzpatrick
- Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Kathryn Phillips
- Kathryn Phillips, PhD, MA, MSN, CHSE, APRN, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
| | - Stephanie Nolan
- Stephanie Nolan, DNP MBA, CPAN, NEA-BC, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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19
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Owens RA, McManus C, Machuca C, Estrin I, Meng W, Keck K, Attia E. Improving psychiatric patient satisfaction during a pandemic. Nurs Manag (Harrow) 2021; 52:6-9. [PMID: 33633006 DOI: 10.1097/01.numa.0000733656.21586.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rebecca A Owens
- At New York State Psychiatric Institute in New York, N.Y., Rebecca A. Owens is the CNO, Christine McManus is the assistant CNO, Christina Machuca is a head nurse, Irene Estrin is a quality analyst, Wei Meng is a quality analyst, Kelly Keck is a quality manager, and Evelyn Attia is the clinical director
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20
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Shear M, Deliberto T, Kerrigan S, Belak L, Attia E. Use of Stimulants in Patients with Comorbid Anorexia Nervosa and Attention-Deficit/Hyperactivity Disorder in a Structured Inpatient Setting. J Dev Behav Pediatr 2021; 42:61-65. [PMID: 33003117 DOI: 10.1097/dbp.0000000000000862] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinicians may be concerned about using psychostimulant medications in patients in whom weight gain is desired because of their potential side effects of appetite suppression and weight loss. This report depicts the successful treatment of 2 adolescent patients with anorexia nervosa (AN) and attention-deficit/hyperactivity disorder (ADHD) in an inpatient eating disorders unit. METHOD A report of 2 clinical cases (ages 19 and 20 years) was used to describe the management of comorbid AN and ADHD. Tolerance to stimulants, meal completion, and ability to restore weight were assessed over the course of hospitalization. RESULTS Behaviorally focused refeeding combined with psychostimulants notably improved symptoms of AN and comorbid ADHD without adverse effects. CONCLUSION Psychostimulant medications may be used successfully in patients with AN and ADHD in the context of structured behavioral treatment designed for weight restoration.
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Affiliation(s)
- Matthew Shear
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - Tara Deliberto
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - Sean Kerrigan
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - Lauren Belak
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - Evelyn Attia
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
- Department of Psychiatry, Columbia University Medical Center, New York, NY
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21
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Abstract
Anorexia nervosa (AN) is a devastating psychiatric disorder characterized by extreme restriction of food intake and low body weight, both associated with significant medical and psychological morbidity. The clinical severity of AN has prompted the consideration and study of behavioral and pharmacological treatments in efforts to establish empirically based methods to reduce the burden of the disorder. Among adolescents, family-based treatment is considered a first-line behavioral treatment. Research continues to explore the efficacy of family-based treatment and predictors of treatment response to further improve outcomes. Several behavioral treatments for adults also exist, including cognitive-behavioral therapy, exposure and response prevention, third-wave acceptance-based treatments, and supportive psychotherapy, all of which help to improve symptoms and promote modest weight gain. Despite this, no one treatment is considered superior, and all existing behavioral approaches leave a proportion of adults symptomatic or at a high risk of relapse. As such, among adults, there is continued need for development of novel, mechanism-based approaches to better target the core symptoms of AN. Although antidepressants impart little benefit on weight or symptoms, the second-generation antipsychotic olanzapine has shown ability to promote modest weight gain in outpatients with AN. Most recently, the field's evolving conceptualization of AN as a biologically based disorder coupled with technological advancements has led to consideration of varying neuromodulation strategies as a potential therapeutic approach that remains under investigation.
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Affiliation(s)
- Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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22
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Glasofer DR, Muratore AF, Attia E, Wu P, Wang Y, Minkoff H, Rufin T, Walsh BT, Steinglass JE. Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa. J Eat Disord 2020; 8:69. [PMID: 33292619 PMCID: PMC7709230 DOI: 10.1186/s40337-020-00348-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. METHODS Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual's likelihood of maintaining inpatient treatment gains. RESULTS One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. CONCLUSIONS Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.
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Affiliation(s)
- Deborah R Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA.
| | - Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
- Center for Eating Disorders, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA
| | - Peng Wu
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Hillary Minkoff
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Teresa Rufin
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
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23
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Abstract
Wonderlich et al.'s manuscript "Severe and Enduring Anorexia Nervosa: Update and Observations about the Current Clinical Reality" reviews Severe and Enduring Anorexia Nervosa (SE-AN) from several perspectives, hoping to stimulate discussion among clinicians, researchers, and other stakeholders about needed next steps for furthering the science relevant to the severe and enduring form of illness that affects a subgroup of individuals with AN. Among the important reasons for a new discussion of SE-AN is that health care has evolved in ways that have reduced comprehensive services for those who are more seriously affected. It is critical that adults with SE-AN be examined empirically to help identify effective strategies for clinical management and that health care policies assure parity for this seriously affected group.
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Affiliation(s)
- Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell College of Medicine, New York, New York, USA
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24
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Steinglass JE, Glasofer DR, Dalack M, Attia E. Between wellness, relapse, and remission: Stages of illness in anorexia nervosa. Int J Eat Disord 2020; 53:1088-1096. [PMID: 32031292 PMCID: PMC7384605 DOI: 10.1002/eat.23237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Psychiatric illnesses, like medical illnesses, can sometimes be considered as progressing through stages. Understanding these stages can lead to a better understanding of pathophysiology, and clarification of prognosis and treatment needs. Opinions from experts in the field of anorexia nervosa (AN) were sought to create a model of stages of illness. METHOD The Delphi approach was used to achieve consensus from a panel of 31 individuals from a range of disciplines with expertise in AN. Over three iterative rounds, participants rated agreement with statements about an overall staging framework and definitions of specific stages. RESULTS Agreement was reached about a longitudinal progression including Subsyndromal, Full Syndrome, Persistent Illness, and Partial and Full Remission. The panel achieved consensus in defining Subsyndromal AN as characterized by body image disturbance and mild to moderate restrictive eating. Overall, there was consensus that restrictive eating is central to the behavioral features of all stages of AN, and agreement that its absence is essential to any stage of health. There was little consensus about biological markers, other than body mass index, and no consensus about quality of life indices associated with different stages. DISCUSSION This panel discussion yielded an expert-informed staging model for AN. This model now needs to be tested for its validity. The lack of consensus in several areas highlighted other research questions to address in order to develop an empirically valid and scientifically useful model of the progression of AN.
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Affiliation(s)
- Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Deborah R. Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Maya Dalack
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center & New York State Psychiatric Institute, New York, New York,Weill Cornell Medical Center, Presbyterian Hospital, White Plains, New York
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25
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Uniacke B, Attia E, Kaplan A, Walsh BT. Weight suppression and weight maintenance following treatment of anorexia nervosa. Int J Eat Disord 2020; 53:1002-1006. [PMID: 32227368 PMCID: PMC7584398 DOI: 10.1002/eat.23269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/08/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The value of weight suppression (WS) in predicting the course of anorexia nervosa (AN) is uncertain. The objective of this study was to determine, using data from a previously published study, whether patients who remain weight suppressed following restoration to a minimally normal weight are at greater risk for relapse. METHOD Following weight restoration, 93 women with AN were randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy for 1 year. WS (highest adult weight minus current weight), body mass index (BMI), and their interaction were assessed as predictors of change in weight over the first 28 days, of successful weight maintenance at 6 and 12 months, and of time to relapse. RESULTS Neither WS nor its interaction with BMI predicted successful weight maintenance at 6 and 12 months, time to relapse, or weight change over the first 28 days following discharge. DISCUSSION This study found that WS does not substantially impact the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight in AN.
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Affiliation(s)
- Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Psychiatry New York State Psychiatric Institute, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Psychiatry New York State Psychiatric Institute, New York, New York
| | - Allan Kaplan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York,Department of Psychiatry New York State Psychiatric Institute, New York, New York
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26
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Ranzenhofer LM, Wilhelmy M, Hochschild A, Sanzone K, Walsh BT, Attia E. Peer mentorship as an adjunct intervention for the treatment of eating disorders: A pilot randomized trial. Int J Eat Disord 2020; 53:497-509. [PMID: 32159243 PMCID: PMC7383944 DOI: 10.1002/eat.23258] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 11/15/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Peer mentorship has been shown to be helpful for other mental health conditions, but it has been understudied for patients with eating disorders. The goal of the present study was to evaluate the feasibility and efficacy of peer mentorship for individuals with eating disorders by conducting a randomized controlled trial (RCT). TRIAL DESIGN Parallel three-arm pilot RCT with 1:1:1 allocation to peer mentorship, social support mentorship (active comparison intervention), and waiting list. METHOD Sixty outpatients with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) were randomly assigned to a condition. Outcome measures, including eating disorder symptoms and general psychopathology, were completed at baseline, mid-, and postintervention. RESULTS Session attendance and acceptability ratings were higher in peer mentorship than social support mentorship. More participants in social support mentorship (39%) dropped out compared to peer mentorship (5%). In intent-to-treat analysis, peer mentorship showed greater reductions in body dissatisfaction and anxiety compared with both control groups. Compared with social support mentorship, peer mentorship had greater reductions in depression. Compared with waiting list, peer mentorship had greater reduction in binge eating days/week in patients with BN/BED and restriction days/week in patients with AN. Peer mentorship did not impact body mass index or reentry into higher level of care. DISCUSSION This pilot RCT provides preliminary evidence that peer mentorship is effective for some cognitive and behavioral symptoms of eating disorders as an adjunct to outpatient treatment. Additional studies are needed to evaluate the efficacy of peer mentorship in absence of treatment.
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Affiliation(s)
- Lisa M. Ranzenhofer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Mylene Wilhelmy
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Annabella Hochschild
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Kaitlin Sanzone
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA,New York State Psychiatric Institute, New York, New York, USA
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Abstract
Eating disorders are serious psychiatric illnesses with high rates of morbidity and mortality. Effective treatments have traditionally included behaviorally focused therapies as well as several medication strategies. Recent years have seen promising developments in these treatments, including additional support for family-based approaches for children and adolescents, new evidence for "third-wave" behavioral therapies, and new support for the use of lisdexamfetamine for binge eating disorder and olanzapine for anorexia nervosa. Case study and pilot data are beginning to show limited support for neuromodulatory interventions targeting brain regions thought to be involved in eating disorders. This review summarizes treatment developments over the last several years and points towards future directions for the field.
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Affiliation(s)
- Lauren E. Davis
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA
- Weill Cornell Medical Center, New York, USA
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28
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Buchman S, Attia E, Dawson L, Steinglass JE. Steps of care for adolescents with anorexia nervosa-A Delphi study. Int J Eat Disord 2019; 52:777-785. [PMID: 31058331 PMCID: PMC7147487 DOI: 10.1002/eat.23088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/12/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) commonly develops during adolescence. Existing literature offers some treatment guidelines, but clear clinical criteria for initial recommendations and steps of care are needed. The aim of the present study was to develop expert consensus for a stepped-care algorithm for treatment of adolescents with AN. METHOD The Delphi approach was used to identify clinical parameters that guide initial treatment recommendations and recommendations for transitions between levels of care. The Delphi approach provides a useful expert consensus when empirical data are limited. Individuals with at least 10 years of experience in the field of adolescent AN and membership in one of three professional organizations were recruited. Twenty-five panelists participated in three rounds of iterative online questionnaires. RESULTS Consensus was achieved on several features of a treatment algorithm. Hospitalization is recommended when medical instability, suicidality, or acute food refusal are present at any point in treatment. Family-based treatment (FBT) is recommended as the first-line treatment, with a few exceptions. Consensus was not reached on when to transition from a higher level of care to a lower level of care. DISCUSSION Expert opinion was used to develop a consensus-based algorithm for care of adolescents with AN. Future research is needed to test whether these recommendations can be used to optimize outcomes for adolescents with AN.
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Affiliation(s)
- Samantha Buchman
- Weill Cornell Medicine, New York-Presbyterian Hospital, White Plains, New York
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
| | - Lisa Dawson
- Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital Sydney, Eating Disorder Service, The Children's Hospital at Westmead, Camperdown, New South Wales, Australia
| | - Joanna E. Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, New York
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29
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Attia E, Steinglass JE, Walsh BT, Wang Y, Wu P, Schreyer C, Wildes J, Yilmaz Z, Guarda A, Kaplan A, Marcus MD. Olanzapine Versus Placebo in Adult Outpatients With Anorexia Nervosa: A Randomized Clinical Trial. Am J Psychiatry 2019; 176:449-456. [PMID: 30654643 PMCID: PMC7015155 DOI: 10.1176/appi.ajp.2018.18101125] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the benefits of olanzapine compared with placebo for adult outpatients with anorexia nervosa. METHODS This randomized double-blind placebo-controlled trial of adult outpatients with anorexia nervosa (N=152, 96% of whom were women; the sample's mean body mass index [BMI] was 16.7) was conducted at five sites in North America. Participants were randomly assigned in a 1:1 ratio to receive olanzapine or placebo and were seen weekly for 16 weeks. The primary outcome measures were rate of change in body weight and rate of change in obsessionality, assessed with the Yale-Brown Obsessive Compulsive Scale (YBOCS). RESULTS Seventy-five participants were assigned to receive olanzapine and 77 to receive placebo. A statistically significant treatment-by-time interaction was observed, indicating that the increase in BMI over time was greater in the olanzapine group (0.259 [SD=0.051] compared with 0.095 [SD=0.053] per month). There was no significant difference between treatment groups in change in the YBOCS obsessions subscale score over time (-0.325 compared with -0.017 points per month) and there were no significant differences between groups in the frequency of abnormalities on blood tests assessing potential metabolic disturbances. CONCLUSIONS This study documented a modest therapeutic effect of olanzapine compared with placebo on weight in adult outpatients with anorexia nervosa, but no significant benefit for psychological symptoms. Nevertheless, the finding on weight is notable, as achieving change in weight is notoriously challenging in this disorder.
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Affiliation(s)
- Evelyn Attia
- Columbia University Irving Medical Center;,New York State Psychiatric Institute;,Weill Cornell Medical College
| | - Joanna E. Steinglass
- Columbia University Irving Medical Center;,New York State Psychiatric Institute
| | - B Timothy Walsh
- Columbia University Irving Medical Center;,New York State Psychiatric Institute
| | | | - Peng Wu
- Columbia University Irving Medical Center
| | | | - Jennifer Wildes
- University of Pittsburgh Medical Center;,University of Chicago
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30
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Schebendach JE, Uniacke B, Walsh BT, Mayer LES, Attia E, Steinglass J. Fat preference and fat intake in individuals with and without anorexia nervosa. Appetite 2019; 139:35-41. [PMID: 30981752 DOI: 10.1016/j.appet.2019.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 02/07/2019] [Revised: 03/29/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Abstract
Fat restriction is a characteristic eating behavior among individuals with anorexia nervosa (AN), and laboratory meal studies demonstrate restricted fat intake among low-weight patients. The Geiselman Food Preference Questionnaire-I© (FPQ) is a validated self-report measure that yields a fat preference score (FPS). Prior research reported that patients with AN had a significantly lower FPS than did healthy control (HC) participants. The goal of the current study was to compare self-reported fat preference (FPS) to fat intake (multi-item meal (MIM) study) in low-weight ANs and HCs. Specific aims were 1) to determine if the FPS differed between ANs and HCs; 2) to determine if fat and energy intakes differed between ANs and HCs; and 3) to determine if the FPS was associated with fat and energy intakes in ANs and HCs. Forty-four female AN inpatients and 48 female HCs completed the FPQ and participated in a MIM study. Compared to HCs, ANs consumed less energy (469.1 ± 397.7 vs. 856.4 ± 346.8 kcal, p < 0.001), less fat (16.4 ± 20.4 vs. 36.7 ± 18.9 g, p < 0.001), and a smaller percentage of calories from fat (22.9 ± 13.8 vs. 36.6 ± 8.0%, p < 0.001) at the MIM. Compared to HCs, ANs also had a lower FPS (79.7 ± 27.4 vs. 102.3 ± 18.9, p < 0.001). The FPS was significantly and positively correlated with caloric intake (r = 0.481, p < 0.01), total fat (r = 0.453, p < 0.01), and the percentage of calories from fat (r = 0.37, p < 0.05) in ANs as well as in HCs (kcal: r = 0.583, p < 0.001; fat: r = 0.621, p < 0.001; % fat kcal: r = 0.601, p < 0.001). The FPS is related to objective measures of energy and fat intake in patients with AN as well as in healthy individuals.
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Affiliation(s)
- Janet E Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA.
| | - Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Laurel E S Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
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31
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Abstract
BACKGROUND Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines. METHODS The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH). RESULTS Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16. CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Deborah R Glasofer
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Emily Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Gabby Guzman
- Rutgers Graduate School of Applied and Professional Psychology
| | | | - B Timothy Walsh
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Evelyn Attia
- Department of Psychiatry,Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute/Department of Psychiatry and Behavioral Science University of North Dakota School of Medicine and Health Sciences
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32
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Guarda AS, Wonderlich S, Kaye W, Attia E. A path to defining excellence in intensive treatment for eating disorders. Int J Eat Disord 2018; 51:1051-1055. [PMID: 30189103 DOI: 10.1002/eat.22899] [Citation(s) in RCA: 12] [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: 04/06/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022]
Abstract
In the United States, the past decade has seen rapid growth in treatment centers providing specialty care to patients with eating disorders. Much of this growth has been in higher levels of care, including hospital-based and residential treatment. Despite this expansion, there remains lack of agreement regarding the most important components of care, such as staff training or specifics of treatment delivery. Additionally there is no consensus on how best to assess outcome and compare performance across programs. This leaves patients, families, public and private insurance programs, and policy makers with limited information to help facilitate treatment decisions. The present paper considers implications of these changes in the eating disorder treatment landscape and examines two ideas that, if implemented, may enhance the quality of eating disorder care. First, we explore the proposal to develop a network of centers of excellence in eating disorder treatment and the value this may have for improving overall treatment quality. This idea was discussed at an expert meeting held at SAMSHA in 2017 regarding issues important to the field following passage of the 21st Century Cures Act. Second, we consider the potential utility of a study using the Delphi method to promote expert consensus regarding clinical outcome assessments.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Stephen Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota, U.S.A.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, U.S.A
| | - Walter Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York, New York, U.S.A.,Department of Psychiatry Weill Cornell Medical College, New York, New York, U.S.A
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33
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Hay P, Touyz S, Arcelus J, Pike K, Attia E, Crosby RD, Madden S, Wales J, La Puma M, Heriseanu AI, Young S, Meyer C. A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa. Int J Eat Disord 2018; 51:999-1004. [PMID: 30051623 DOI: 10.1002/eat.22920] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 12/12/2017] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.
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Affiliation(s)
- Phillipa Hay
- Discipline of Mental Health, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Stephen Touyz
- Department of Clinical Psychology, School of Psychology, University of Sydney, Sydney, Australia
| | - Jon Arcelus
- Faculty of Medicine & Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.,Department of Psychiatry, Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York, New York
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Sloane Madden
- Department of Psychiatry, Eating Disorders Service at the Sydney Children's Hospitals Network, Sydney, Australia
| | - Jackie Wales
- Department of Psychiatry, Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, United Kingdom
| | | | - Andreea I Heriseanu
- Department of Clinical Psychology, School of Psychology, University of Sydney, Sydney, Australia
| | - Sarah Young
- Department of Psychiatry, Eating Disorders Service at the Sydney Children's Hospitals Network, Sydney, Australia
| | - Caroline Meyer
- Discipline of Behavioural Psychology, WMG and Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Discipline of Psychology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Cyr M, Fontaine B.S. M, Stefan M, Terranova K, Kopala-Sibley DC, Attia E, Marsh R. A longitudinal functional magnetic resonance imaging study of task control circuits and bulimic symptoms over adolescence. J Child Psychol Psychiatry 2018; 59:752-762. [PMID: 29114852 PMCID: PMC6731764 DOI: 10.1111/jcpp.12840] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Accepted: 10/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Previous cross-sectional findings from adolescents and adults with Bulimia Nervosa (BN) suggest disturbances in fronto-striatal and cingulo-opercular task control circuits that support self-regulatory processes, including the resolution of cognitive conflict. Herein, we used longitudinal data to examine the developmental trajectories of such disturbances and how the functioning of these circuits relates to changes in BN symptoms over adolescence. METHODS Thirty-two adolescent females with BN symptoms and 28 healthy control (HC) adolescents participated in the study. Functional magnetic resonance images (fMRI) during performance of a Simon task were acquired at three time points within 2-year intervals over adolescence. From the initial sample, 70% and 30% of the participants completed the second and third time points, respectively. Participants who completed all study time points did not differ from those lost to attrition on baseline demographic characteristics or any outcome measures. Using a region-of-interest approach, growth curve models tested group differences in the trajectory of conflict-related activation in task control circuits over time. Cross-lagged panel models examined transactional relationships between conflict-related activation in the same regions and BN symptoms over time. RESULTS Growth curve models revealed different trajectories of conflict-related activation in right task control regions across BN and HC adolescents, such that HC but not BN adolescents showed activation decreases over time. These group differences were greatest when including only the BN adolescents whose symptoms remitted over time. Cross-lagged panel models revealed that less frequent bulimic episodes at first follow-up predicted later increases in conflict-related activation in bilateral task control regions. CONCLUSIONS These longitudinal findings suggest overengagement of task control circuits in BN adolescents, especially those most resilient to persistent illness. Such overengagement may compensate for regulatory disturbances, allowing them to regulate eating behaviors over development. Thus, task control circuits may constitute targets for early interventions that enhance self-regulatory control.
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Affiliation(s)
- Marilyn Cyr
- Division of Child and Adolescent Psychiatry in the Department of Psychiatry, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Martine Fontaine B.S.
- Division of Child and Adolescent Psychiatry in the Department of Psychiatry, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Mihaela Stefan
- Division of Child and Adolescent Psychiatry in the Department of Psychiatry, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Kate Terranova
- Division of Child and Adolescent Psychiatry in the Department of Psychiatry, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | | | - Evelyn Attia
- Eating Disorders Research Unit, Division of Clinical Therapeutics in the Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Rachel Marsh
- Division of Child and Adolescent Psychiatry in the Department of Psychiatry, New York State Psychiatric Institute and Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY
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35
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Guarda AS, Attia E. Evidence‐based practice and the residential treatment of eating disorders: Time to raise the bar. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/cpsp.12232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Young S, Touyz S, Meyer C, Arcelus J, Rhodes P, Madden S, Pike K, Attia E, Crosby RD, Hay P. Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa. J Eat Disord 2018; 6:2. [PMID: 29441204 PMCID: PMC5799909 DOI: 10.1186/s40337-018-0188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. METHOD A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. RESULTS Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. CONCLUSIONS These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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Affiliation(s)
- Sarah Young
- Griffith Taylor Building, School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Meyer
- WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sloane Madden
- School of Medicine, University of Sydney, Sydney, Australia
- Eating Disorders Service at the Sydney Children’s Hospitals Network, Westmead, Australia
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Weill Cornell Medical College, New York, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota USA
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
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37
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Berner LA, Stefan M, Lee S, Wang Z, Terranova K, Attia E, Marsh R. Altered cortical thickness and attentional deficits in adolescent girls and women with bulimia nervosa. J Psychiatry Neurosci 2018; 43:170070. [PMID: 29336774 PMCID: PMC5915236 DOI: 10.1503/jpn.170070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/10/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Frontostriatal and frontoparietal abnormalities likely contribute to deficits in control and attentional processes in individuals with bulimia nervosa and to the persistence of dysregulated eating across development. This study assessed these processes and cortical thickness in a large sample of adolescent girls and women with bulimia nervosa compared with healthy controls. METHODS We collected anatomical MRI data from adolescent girls and women (ages 12-38 yr) with full or subthreshold bulimia nervosa and age-matched healthy controls who also completed the Conners Continuous Performance Test-II (CPT-II). Groups were compared on task performance and cortical thickness. Mediation analyses explored associations among cortical thickness, CPT-II variables, bulimia nervosa symptoms and age. RESULTS We included 60 girls and women with bulimia nervosa and 54 controls in the analyses. Compared with healthy participants, those with bulimia nervosa showed increased impulsivity and inattention on the CPT-II, along with reduced thickness of the right pars triangularis, right superior parietal and left dorsal posterior cingulate cortices. In the bulimia nervosa group, exploratory analyses revealed that binge eating frequency correlated inversely with cortical thickness of frontoparietal and insular regions and that reduced frontoparietal thickness mediated the association between age and increased symptom severity and inattention. Binge eating frequency also mediated the association between age and lower prefrontal cortical thickness. LIMITATIONS These findings are applicable to only girls and women with bulimia nervosa, and our cross-sectional design precludes understanding of whether cortical thickness alterations precede or result from bulimia nervosa symptoms. CONCLUSION Structural abnormalities in the frontoparietal and posterior cingulate regions comprising circuits that support control and attentional processes should be investigated as potential contributors to the maintenance of bulimia nervosa and useful targets for novel interventions.
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Affiliation(s)
- Laura A Berner
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Mihaela Stefan
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Seonjoo Lee
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Zhishun Wang
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Kate Terranova
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Evelyn Attia
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
| | - Rachel Marsh
- From the Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego (Berner); the Division of Child and Adolescent Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Stefan, Lee, Wang, Terranova, Marsh); and the Eating Disorders Research Unit, Division of Clinical Therapeutics, Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute (Attia, Marsh)
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Belak L, Deliberto T, Shear M, Kerrigan S, Attia E. Inviting eating disorder patients to discuss the academic literature: a model program for psychoeducation. J Eat Disord 2017; 5:49. [PMID: 29142754 PMCID: PMC5670507 DOI: 10.1186/s40337-017-0178-7] [Citation(s) in RCA: 2] [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: 05/06/2017] [Accepted: 10/25/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Psychoeducation initiatives in which patients read primary scientific literature have not yet been studied as a treatment intervention for eating disorders. In this paper, we discuss and evaluate the acceptability of a novel psychoeducational journal club for individuals with anorexia and bulimia nervosa in inpatient and partial hospitalization program settings. Primary literature about eating disorders is presented and discussed with patients. By presenting scientifically-supported information, our "Psychoeducational Research Group" is designed to help patients restructure disordered thoughts and encourage adherence to evidence-based treatment. METHODS Using a Likert scale questionnaire (0 = not at all; 5 = very much), participants provided ratings for how much they liked the group and felt that it helped them across several domains. RESULTS Average scores from 33 participants (26 inpatient, 7 partial hospital patients) indicated they would recommend this group to others receiving eating disorder treatment (4.8 ± 0.6). Scores also suggested patients' likeability (4.6 ± 0.8), benefit regarding challenging eating disorder thoughts (4.1 ± 1.1), improved motivation for eating behavior change (4.0 ± 1.0) and completion of prescribed nutritional plan (3.6 ± 1.0), and usefulness in working towards treatment goals (4.2 ± 0.9) associated with group participation. CONCLUSIONS Preliminary findings support the acceptability of this psychoeducational group and that it may serve as a useful adjunct to larger evidence-based programming across eating disorder treatment settings.
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Affiliation(s)
- Lauren Belak
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Tara Deliberto
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Matthew Shear
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Sean Kerrigan
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
| | - Evelyn Attia
- Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, White Plains, NY 10605 USA
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032 USA
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39
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Gianini L, Roberto CA, Attia E, Walsh BT, Thomas JJ, Eddy KT, Grilo CM, Weigel T, Sysko R. Mild, moderate, meaningful? Examining the psychological and functioning correlates of DSM-5 eating disorder severity specifiers. Int J Eat Disord 2017; 50:906-916. [PMID: 28489323 PMCID: PMC5538916 DOI: 10.1002/eat.22728] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 08/09/2016] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study evaluated the DSM-5 severity specifiers for treatment-seeking groups of participants with anorexia nervosa (AN), the purging form of bulimia nervosa (BN), and binge-eating disorder (BED). METHOD Hundred and sixty-two participants with AN, 93 participants with BN, and 343 participants with BED were diagnosed using semi-structured interviews, sub-categorized using DSM-5 severity specifiers and compared on demographic and cross-sectional clinical measures. RESULTS In AN, the number of previous hospitalizations and the duration of illness increased with severity, but there was no difference across severity groups on measures of eating pathology, depression, or measures of self-reported physical or emotional functioning. In BN, the level of eating concerns increased across the severity groups, but the groups did not differ on measures of depression, self-esteem, and most eating pathology variables. In BN, support was also found for an alternative severity classification scheme based upon number of methods of purging. In BED, levels of several measures of eating pathology and self-reported physical and emotional functioning increased across the severity groups. For BED, however, support was also found for an alternative severity classification scheme based upon overvaluation of shape and weight. Preliminary evidence was also found for a transdiagnostic severity index based upon overvaluation of shape and weight. DISCUSSION Overall, these data show limited support for the DSM-5 severity specifiers for BN and modest support for the DSM-5 severity specifiers for AN and BED.
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Affiliation(s)
- Loren Gianini
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, United States, 10032,Corresponding author: Loren Gianini, Columbia Center for Eating Disorders, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032. Fax=646-774-7513, Telephone=646-774-5249,
| | - Christina A. Roberto
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, United States, 19104
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, United States, 10032
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, United States, 10032
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, United States, 02114,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States, 02115
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA, United States, 02114,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, United States, 02115
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT, United States, 06519,Department of Psychology, Yale University, Box 208205, New Haven, CT, United States, 06520
| | - Thomas Weigel
- Klarman Center, McLean Hospital and Harvard Medical School, Belmont, MA, 02478
| | - Robyn Sysko
- Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, United States, 10029
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40
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Young S, Touyz S, Meyer C, Arcelus J, Rhodes P, Madden S, Pike K, Attia E, Crosby RD, Wales J, Hay P. Validity of Exercise Measures in Adults with Anorexia Nervosa: The EDE, Compulsive Exercise Test and Other Self-Report Scales. Int J Eat Disord 2017; 50:533-541. [PMID: 27696468 DOI: 10.1002/eat.22633] [Citation(s) in RCA: 30] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/06/2016] [Accepted: 09/08/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample. METHODS The sample consisted of 78 adults with AN, recruited for the randomized controlled trial "Taking a LEAP forward in the treatment of anorexia nervosa." At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed. RESULTS EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample. DISCUSSION The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:533-541).
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Affiliation(s)
- Sarah Young
- School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Meyer
- WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, United Kingdom and Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, United Kingdom
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sloane Madden
- Sydney Children's Hospital Network, Westmead, Australia and School of Medicine, The University of Sydney, Sydney, Australia
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota.,University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Jackie Wales
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, United Kingdom
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown, Australia
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41
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Wildes JE, Forbush KT, Hagan KE, Marcus MD, Attia E, Gianini LM, Wu W. Characterizing severe and enduring anorexia nervosa: An empirical approach. Int J Eat Disord 2017; 50:389-397. [PMID: 27991694 PMCID: PMC5386793 DOI: 10.1002/eat.22651] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 06/24/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/07/2022]
Abstract
Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN (N = 355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice.
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Affiliation(s)
- Jennifer E. Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | | | - Kelsey E. Hagan
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Loren M. Gianini
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Wei Wu
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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42
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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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43
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Attia E, Marcus MD, Walsh BT, Guarda AS. The need for consistent outcome measures in eating disorder treatment programs: A proposal for the field. Int J Eat Disord 2017; 50:231-234. [PMID: 28130819 DOI: 10.1002/eat.22665] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY.,Department of Psychiatry, Weill Cornell Medical College, New York, NY
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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44
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Schebendach JE, Call CC, Attia E, Devlin MJ, Timothy Walsh B, Mayer LES. The effect of acute weight restoration on dietary fat preference in hospitalized patients with anorexia nervosa. Int J Eat Disord 2017; 50:148-151. [PMID: 27610952 DOI: 10.1002/eat.22620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/08/2016] [Revised: 07/06/2016] [Accepted: 08/09/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Individuals with anorexia nervosa (AN) restrict fat intake. The Geiselman Food Preference Questionnaire-I© (FPQ) is a validated self-report instrument that yields a fat preference score (>100 = high fat preference, <100 = low fat preference). The goal of the study was to assess the utility of the FPQ in patients with AN. SPECIFIC AIMS (1) to examine change in fat preference scores before and after weight restoration in hospitalized patients; and (2) to compare patients' scores before and after weight restoration to scores from healthy participants (HPs). METHOD The FPQ was completed by 88 patients and 115 HPs. RESULTS Compared with HPs, patients had significantly lower fat preference scores before (74.03 ± 32.03 vs. 102.93 ± 16.89, P < 0.001) and after (81.51 ± 26.89 vs. 102.92 ± 16.89, P < 0.001) weight restoration. Fat preference scores increased with weight gain (74.03 + 32.03 vs. 81.51 + 26.89, P < 0.01) but did not normalize in AN. DISCUSSION Acutely weight restored patients continue to endorse decreased preference for high fat foods. The FPQ may be a useful metric by which to assess improvements in diet during treatment. Further study is warranted to validate the FPQ against observed food intake in AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:148-151).
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Affiliation(s)
- Janet E Schebendach
- Columbia University College of Physicians and Surgeons, New York, NY 10032; New York State Psychiatric Institute, New York, New York
| | - Christine C Call
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Evelyn Attia
- Columbia University College of Physicians and Surgeons; New York State Psychiatric Institute, New York, New York
| | - Michael J Devlin
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - B Timothy Walsh
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - Laurel E S Mayer
- Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
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45
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Belak L, Gianini L, Klein DA, Sazonov E, Keegan K, Neustadt E, Walsh BT, Attia E. Measurement of fidgeting in patients with anorexia nervosa using a novel shoe-based monitor. Eat Behav 2017; 24:45-48. [PMID: 28011408 PMCID: PMC5258678 DOI: 10.1016/j.eatbeh.2016.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 07/18/2016] [Revised: 11/14/2016] [Accepted: 11/30/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To objectively assess seated non-exercise physical activity in patients with anorexia nervosa (AN) relative to healthy controls (HCs) and examine the associations between this physical activity, eating disorder pathology, and levels of anxiety and depression. METHOD Eleven inpatients with AN and 10 HCs wore a shoe-based accelerometer (SmartShoe) at three time points: a) while eating lunch, b) filling out questionnaires, and c) watching television for 1h. RESULTS Across all three tasks, patients with AN were significantly more active than HCs, thereby engaging in a greater degree of restless or fidgeting behavior. Degree of physical activity was positively correlated with eating disorder psychopathology in the sample with AN, and a trend towards a positive association between physical activity and levels of depression and anxiety was also found in this sample. Among individuals with AN, physical activity was not significantly correlated with BMI, duration of illness, or number of days since hospital admission. DISCUSSION Use of a minimally invasive, shoe-based monitor revealed patients with AN engaged in a greater degree of fidgeting relative to HCs during quiet, seated tasks and this heightened activity was related to measures of pathology. Non-exercise physical activity, including fidgeting, may warrant further clinical attention in this patient population.
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Affiliation(s)
- Lauren Belak
- Department of Psychiatry, Weill Cornell Medical Center-Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605, United States.
| | - Loren Gianini
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, United States.
| | - Diane A. Klein
- Department of Psychiatry, New York University Langone Medical Center, One Park Avenue, 8-131, New York, New York, United States, 10016
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL, United States, 35487.
| | - Kathryn Keegan
- Department of Psychiatry, New York University Langone Medical Center, One Park Avenue, 8-131, New York, NY 10016, United States.
| | - Esther Neustadt
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, United States.
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, United States.
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Schebendach J, Klein DA, Mayer LES, Attia E, Devlin MJ, Foltin RW, Walsh BT. Assessment of the motivation to use artificial sweetener among individuals with an eating disorder. Appetite 2016; 109:131-136. [PMID: 27884761 DOI: 10.1016/j.appet.2016.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/28/2016] [Revised: 11/04/2016] [Accepted: 11/19/2016] [Indexed: 10/20/2022]
Abstract
Eating disorders are associated with a range of abnormalities in eating behavior. Some individuals consume large amounts of non-caloric artificial sweeteners, suggesting abnormalities in appetitive responding. The current study aimed to quantify hedonic and motivating effects of artificial sweetener in individuals with and without an eating disorder. Two laboratory studies were conducted. Hedonic preference was estimated using the number of artificial sweetener packets (0-10) added to unsweetened cherry flavored Kool-Aid (study 1). Motivation to obtain sweetener was assessed by a progressive ratio (PR) work task (study 2). Ninety-three participants (25 anorexia nervosa restricting type (AN-R), 23 AN binge/purge type (AN-B/P), 20 bulimia nervosa (BN), and 25 normal controls (NC)) completed the study. No significant difference in hedonic preference was found among participant groups. Work completed at the PR task ranged from 0 to 9500 key-board presses. The AN-B/P group had a significantly higher breakpoint and performed significantly more work for sweetener compared to the BN and NC groups. Among AN-B/P and AN-R participants, the preferred number of Equal packets was significantly correlated with the breakpoint and total work. The increased amount of work for sweetener among individuals with AN-B/P supports an enhanced reward value of sweet taste in this population, and suggests that the characteristic food avoidance in AN cannot be accounted for by decreased reward value of all taste-related stimuli. This study also supports the novel application of a PR ratio task to quantify the motivating effect of sweet taste among individuals with an eating disorder.
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Affiliation(s)
- Janet Schebendach
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA.
| | - Diane A Klein
- New York University, Langone Medical Center, Department of Psychiatry, USA
| | - Laurel E S Mayer
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Evelyn Attia
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Michael J Devlin
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - Richard W Foltin
- Division on Substance Abuse, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
| | - B Timothy Walsh
- Eating Disorders Research Unit, New York State Psychiatric Institute, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA; Columbia University Medical Center, New York, NY 10032, USA
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47
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Rouet L, Mory B, Attia E, Bredahl K, Long A, Ardon R. A minimally interactive and reproducible method for abdominal aortic aneurysm quantification in 3D ultrasound and computed tomography with implicit template deformations. Comput Med Imaging Graph 2016; 58:75-85. [PMID: 27939282 DOI: 10.1016/j.compmedimag.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/09/2016] [Revised: 09/20/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The maximum diameter of abdominal aortic aneurysm (AAA) is a key quantification parameter for disease assessment. Although it is routinely measured on 2D-ultrasound images, using a volumetric approach is expected to improve measurement reproducibility. In this work, 3D-ultrasound or computed tomography imaging of patients with AAA was combined with a minimally interactive 3D segmentation based on implicit template deformation. Segmentation usability and reproducibility were evaluated on 81 patients, showing a mean measurement time of [2;8]min per case, and Dice coefficients of 0.87±0.12 for 3D-US and 0.81±0.08 for CT. Quantification parameters included a diameter measurement from 3D-US and CT volumes with respective confidence intervals of 0.51 [-2.5;3.52]mm and 1.00 [-1.68;3.67]mm. Additional volume measurements showed confidence intervals of 0.91 [-4.17;5.99]ml for 3D-US and 4.10 [-4.11;12.30]ml for CT.
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Affiliation(s)
- L Rouet
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France.
| | - B Mory
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
| | - E Attia
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
| | - K Bredahl
- Department of Vascular Surgery, Rigshospitalet, Univ. of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - A Long
- Médecine Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - R Ardon
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
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48
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Gianini LM, Klein DA, Call C, Mayer L, Foltin RW, Walsh BT, Wang Y, Wu P, Attia E. The reinforcing effect of exercise in anorexia nervosa: Clinical correlates and relationship to outcome. Eat Disord 2016; 24:412-23. [PMID: 27348805 PMCID: PMC6742425 DOI: 10.1080/10640266.2016.1198204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of the current study was to examine the relative reinforcing effect of exercise compared to a non-monetary alternative reinforcer (leisure activity), and to money, before and after weight restoration in an inpatient population with anorexia nervosa (AN). Sixty-two inpatients with AN completed a progressive ratio (PR) task to earn exercise, leisure activities, or cash at low weight and after weight restoration. Measures of pathology and motivation to exercise were completed and post-treatment discharge weights were collected. Patients worked harder for exercise at low weight than after weight restoration (df = 46, t = 5.50, p < .001). PR task performance was weakly associated with a measure of commitment to exercise (low weight: r = 0.31, weight restored: r = 0.36, p < .05), but not with other clinical measures or follow-up weights. Contrary to prior suggestions, measurement of the reinforcing value of exercise among individuals with AN via a PR task does not appear valuable in assessing clinical severity or outcome. Other, simpler, self-report measures of commitment to exercise may have greater value in assessing these outcomes.
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Affiliation(s)
- Loren M Gianini
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - Diane A Klein
- b Department of Psychiatry , New York University Langone Medical Center , New York , New York , USA
| | - Christine Call
- c Department of Psychology , Drexel University , Philadelphia , Pennsylvania , USA
| | - Laurel Mayer
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - Richard W Foltin
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - B Timothy Walsh
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - Yuanjia Wang
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - Peng Wu
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
| | - Evelyn Attia
- a Department of Psychiatry , Columbia University Medical Center, New York State Psychiatric Institute , New York , New York , USA
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Abstract
Residential behavioral treatment is a growing sector of the health care industry and is used by a large proportion of adolescent and adult patients with eating disorders. These programs and the organizations that own them have developed extensive marketing strategies that target clinicians and include promotional gifts, meals, travel reimbursement, and continuing education credit. Legislation and policy changes have limited these types of activities when conducted by the pharmaceutical industry, and awareness of conflicts of interest associated with clinician-targeted advertising of drugs and devices has increased. However, similar practices by the behavioral health care industry have evolved without oversight. The authors urge clinicians to consider how marketing strategies by treatment facilities may influence their referral behaviors and call for improved transparency regarding gifts and payments from treatment facilities.
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Affiliation(s)
- Evelyn Attia
- Dr. Attia is with the Department of Psychiatry, and Ms. Blackwood and Dr. Rothman are with the Center on Medicine as a Profession, all at Columbia University Medical Center, New York City (e-mail: ). Dr. Attia is also with the Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. Dr. Guarda is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. Dr. Marcus is with Western Psychiatric Institute, Pittsburgh, Pennsylvania
| | - Kristy L Blackwood
- Dr. Attia is with the Department of Psychiatry, and Ms. Blackwood and Dr. Rothman are with the Center on Medicine as a Profession, all at Columbia University Medical Center, New York City (e-mail: ). Dr. Attia is also with the Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. Dr. Guarda is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. Dr. Marcus is with Western Psychiatric Institute, Pittsburgh, Pennsylvania
| | - Angela S Guarda
- Dr. Attia is with the Department of Psychiatry, and Ms. Blackwood and Dr. Rothman are with the Center on Medicine as a Profession, all at Columbia University Medical Center, New York City (e-mail: ). Dr. Attia is also with the Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. Dr. Guarda is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. Dr. Marcus is with Western Psychiatric Institute, Pittsburgh, Pennsylvania
| | - Marsha D Marcus
- Dr. Attia is with the Department of Psychiatry, and Ms. Blackwood and Dr. Rothman are with the Center on Medicine as a Profession, all at Columbia University Medical Center, New York City (e-mail: ). Dr. Attia is also with the Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. Dr. Guarda is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. Dr. Marcus is with Western Psychiatric Institute, Pittsburgh, Pennsylvania
| | - David J Rothman
- Dr. Attia is with the Department of Psychiatry, and Ms. Blackwood and Dr. Rothman are with the Center on Medicine as a Profession, all at Columbia University Medical Center, New York City (e-mail: ). Dr. Attia is also with the Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. Dr. Guarda is with the Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland. Dr. Marcus is with Western Psychiatric Institute, Pittsburgh, Pennsylvania
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50
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Gianini LM, Klein DA, Call C, Walsh BT, Wang Y, Wu P, Attia E. Physical activity and post-treatment weight trajectory in anorexia nervosa. Int J Eat Disord 2016; 49:482-9. [PMID: 26712105 PMCID: PMC4870133 DOI: 10.1002/eat.22495] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/19/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study compared an objective measurement of physical activity (PA) in individuals with anorexia nervosa (AN) at low-weight, weight-restored, and post-treatment time points, and also compared PA in AN with that of healthy controls (HC). METHOD Sixty-one female inpatients with AN wore a novel accelerometer (the IDEEA) which measured PA at three time points: a) low-weight, b) weight-restored, and c) one month post-hospital discharge. Twenty-four HCs wore the IDEEA at one time point. RESULTS Inpatients with AN became more physically active than they were at low-weight at weight restoration and following treatment discharge. Post-treatment patients with AN were more physically active than HCs during the day and less active at night, which was primarily accounted for by amount of time spent on feet, including standing and walking. Greater time spent on feet during the weight-restoration time point of inpatient treatment was associated with more rapid decrease in BMI over the 12 months following treatment discharge. Fidgeting did not differ between patients and controls, did not change with weight restoration, and did not predict post-treatment weight change. DISCUSSION Use of a novel accelerometer demonstrated greater PA in AN than in HC. PA following weight restoration in AN, particularly time spent in standing postures, may contribute to weight loss in the year following hospitalization. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:482-489).
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Affiliation(s)
- Loren M Gianini
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032,Corresponding Author: Loren Gianini, Columbia University Medical Center, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032; ; Phone: +1(646)774-5249
| | - Diane A Klein
- Department of Psychiatry, New York University Langone Medical Center, One Park Avenue, 8-131, New York, New York, United States, 10016 (Klein: )
| | - Christine Call
- Department of Psychology, Drexel University, 3141 Chestnut Street, Philadelphia, PA United States, 19104 (Call: )
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032
| | - Peng Wu
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, New York, United States, 10032
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