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Spencer L, Schmidt-Hantke J, Allen K, Gordon G, Potterton R, Musiat P, Hagner F, Beintner I, Vollert B, Nacke B, Görlich D, Beecham J, Bonin EM, Jacobi C, Schmidt U. A web-based intervention for carers of individuals with anorexia nervosa (We Can): Trial protocol of a randomised controlled trial investigating the effectiveness of different levels of support. Internet Interv 2019; 16:76-85. [PMID: 30775267 PMCID: PMC6364327 DOI: 10.1016/j.invent.2018.02.005] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/17/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening mental disorder that is associated with substantial caregiver burden. Carers of individuals with AN report high levels of distress and self-blame, and insufficient knowledge to help their loved ones. However, carers can have a very important role to play in aiding recovery from AN, and are often highly motivated to assist in the treatment process. This manuscript presents the protocol for a randomised controlled trial (RCT) of We Can, a web-based intervention for carers for people with AN. The study aims to investigate the effectiveness of We Can delivered with different intensities of support. METHODS The study takes the form of a multi-site, two-country, three group RCT, comparing We Can (a) with clinician messaging support (We Can-Ind), (b) with moderated carer chatroom support (We Can-Chat) and (c) with online forum only (We Can-Forum). Participants will be 303 carers of individuals with AN as well as, where possible, the individuals with AN themselves. Recruitment will be via specialist eating disorder services and carer support services in the UK and Germany. Randomisation of carers to one of the three intervention conditions in a 1:1:1 ratio will be stratified by whether or not the individual with AN has (a) agreed to participate in the study and (b) is a current inpatient. The We Can intervention will be provided to carers online over a period of 12 weeks. Participants will complete self-report questionnaires at pre-intervention (T1), mid-intervention (mediators only; 4-weeks post-randomisation), post-intervention (T2; 3-months post randomisation), and 6 months (T3) and 12 months (T4) after randomisation. The primary outcome variables are carer symptoms of depression and anxiety. Secondary outcome variables will be measured in both carers and individuals with AN. Secondary carer outcome variables will include alcohol and drug use and quality of life, caregiving behaviour, and the acceptability and use of We Can and associated supports. Secondary outcomes measured in individuals with AN will include eating disorder symptoms, and symptoms of depression and anxiety. The study will also evaluate the cost-effectiveness of the three We Can conditions, and test for mediators and moderators of the effects of We Can. The trial is registered at the International Standard Randomisation Controlled Trial Number (ISRCTN) database, registration number: ISRCTN11399850. DISCUSSION The study will provide insight into the effectiveness of We Can and its optimal method/s of delivery.
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Key Words
- AESED, accommodation and enabling scale for eating disorders
- AN, anorexia nervosa
- AQoL-8D, assessment of quality of Life-8D
- AUDIT, alcohol use disorders identification test
- Anorexia nervosa
- BDSEE, brief dyadic scale of expressed emotion
- BFI-10, Big Five – 10 item version
- BMI, body mass index
- CASK, caregiver skills scale
- CD-RISC-10, Connor–Davidson resilience scale-10
- CEQ, adapted credibility/expectancy questionnaire
- CSRI, client service receipt inventory
- Carer support
- DUDIT, drug use disorders identification test
- E-treatment
- ECI, experience of caregiving inventory
- EDE-Q, eating disorder examination-questionnaire
- EDSIS, eating disorders symptom impact scale
- GAD-7, generalized anxiety disorder (GAD)-7 scale
- ICare
- Mental health
- OAO, overcoming anorexia online
- Online interventions
- PHQ-9, patient health questionnaire 9-item depression scale
- RCT, randomised controlled trial
- RSE, rosenberg self-esteem scale
- WAI-SR, adapted working alliance inventory – short revised
- WHOQOL, World Health Organisation quality of life scale
- We Can-Chat, We Can with moderated carer chatroom support
- We Can-Forum, We Can with online forum support only
- We Can-Ind, We Can with clinician email support
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Affiliation(s)
- Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Karina Allen
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Franziska Hagner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
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Ozawa Y, Ichimura H, Sakai M. Reexpansion pulmonary edema after surgery for spontaneous pneumothorax in a patient with anorexia nervosa. Ann Med Surg (Lond) 2016; 7:20-3. [PMID: 27158490 PMCID: PMC4843096 DOI: 10.1016/j.amsu.2016.02.019] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/05/2016] [Accepted: 02/13/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Several adverse effects on the pulmonary system in patients with anorexia nervosa (AN) have been reported. We present a case of AN who presented with a complicated reexpansion pulmonary edema (RPE) after video-assisted thoracic surgery (VATS) for spontaneous pneumothorax. Presentation of case A 23-year-old woman with severe anorexia nervosa (weight: 25 kg, body mass index: 8.96 kg/m2) underwent VATS for spontaneous pneumothorax. Five hours after the surgery, she immediately presented acute cardiorespiratory insufficiency. Chest radiography showed an infiltrating shadow in the entire right lung. She was diagnosed with reexpansion pulmonary edema that was treated with methylprednisolone pulse therapy and mechanical ventilation. She recovered and was extubated on postoperative day 4. The chest drain tube was removed on postoperative day 5. Discussion Bullectomy or ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. In our case, bullae were identified in preoperative CT and we chose ligation of the bullae instead of the bullectomy using automatic suture device because of poor wound healing concerned. Conclusion We present a case of RPE after VATS for spontaneous pneumothorax in a patient with AN. Malnutrition owing to AN results in critical complications such as RPE. Ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. Anorexia nervosa results in critical complications such as RPE. Malnutrition due to AN changes the architectural changes in the lung.
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Affiliation(s)
- Yuichiro Ozawa
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
| | - Mitsuaki Sakai
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
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Val-Laillet D, Aarts E, Weber B, Ferrari M, Quaresima V, Stoeckel L, Alonso-Alonso M, Audette M, Malbert C, Stice E. Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. Neuroimage Clin 2015; 8:1-31. [PMID: 26110109 PMCID: PMC4473270 DOI: 10.1016/j.nicl.2015.03.016] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/11/2022]
Abstract
Functional, molecular and genetic neuroimaging has highlighted the existence of brain anomalies and neural vulnerability factors related to obesity and eating disorders such as binge eating or anorexia nervosa. In particular, decreased basal metabolism in the prefrontal cortex and striatum as well as dopaminergic alterations have been described in obese subjects, in parallel with increased activation of reward brain areas in response to palatable food cues. Elevated reward region responsivity may trigger food craving and predict future weight gain. This opens the way to prevention studies using functional and molecular neuroimaging to perform early diagnostics and to phenotype subjects at risk by exploring different neurobehavioral dimensions of the food choices and motivation processes. In the first part of this review, advantages and limitations of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT), pharmacogenetic fMRI and functional near-infrared spectroscopy (fNIRS) will be discussed in the context of recent work dealing with eating behavior, with a particular focus on obesity. In the second part of the review, non-invasive strategies to modulate food-related brain processes and functions will be presented. At the leading edge of non-invasive brain-based technologies is real-time fMRI (rtfMRI) neurofeedback, which is a powerful tool to better understand the complexity of human brain-behavior relationships. rtfMRI, alone or when combined with other techniques and tools such as EEG and cognitive therapy, could be used to alter neural plasticity and learned behavior to optimize and/or restore healthy cognition and eating behavior. Other promising non-invasive neuromodulation approaches being explored are repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS). Converging evidence points at the value of these non-invasive neuromodulation strategies to study basic mechanisms underlying eating behavior and to treat its disorders. Both of these approaches will be compared in light of recent work in this field, while addressing technical and practical questions. The third part of this review will be dedicated to invasive neuromodulation strategies, such as vagus nerve stimulation (VNS) and deep brain stimulation (DBS). In combination with neuroimaging approaches, these techniques are promising experimental tools to unravel the intricate relationships between homeostatic and hedonic brain circuits. Their potential as additional therapeutic tools to combat pharmacorefractory morbid obesity or acute eating disorders will be discussed, in terms of technical challenges, applicability and ethics. In a general discussion, we will put the brain at the core of fundamental research, prevention and therapy in the context of obesity and eating disorders. First, we will discuss the possibility to identify new biological markers of brain functions. Second, we will highlight the potential of neuroimaging and neuromodulation in individualized medicine. Third, we will introduce the ethical questions that are concomitant to the emergence of new neuromodulation therapies.
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Key Words
- 5-HT, serotonin
- ADHD, attention deficit hyperactivity disorder
- AN, anorexia nervosa
- ANT, anterior nucleus of the thalamus
- B N, bulimia nervosa
- BAT, brown adipose tissue
- BED, binge eating disorder
- BMI, body mass index
- BOLD, blood oxygenation level dependent
- BS, bariatric surgery
- Brain
- CBF, cerebral blood flow
- CCK, cholecystokinin
- Cg25, subgenual cingulate cortex
- DA, dopamine
- DAT, dopamine transporter
- DBS, deep brain stimulation
- DBT, deep brain therapy
- DTI, diffusion tensor imaging
- ED, eating disorders
- EEG, electroencephalography
- Eating disorders
- GP, globus pallidus
- HD-tDCS, high-definition transcranial direct current stimulation
- HFD, high-fat diet
- HHb, deoxygenated-hemoglobin
- Human
- LHA, lateral hypothalamus
- MER, microelectrode recording
- MRS, magnetic resonance spectroscopy
- Nac, nucleus accumbens
- Neuroimaging
- Neuromodulation
- O2Hb, oxygenated-hemoglobin
- OCD, obsessive–compulsive disorder
- OFC, orbitofrontal cortex
- Obesity
- PD, Parkinson's disease
- PET, positron emission tomography
- PFC, prefrontal cortex
- PYY, peptide tyrosine tyrosine
- SPECT, single photon emission computed tomography
- STN, subthalamic nucleus
- TMS, transcranial magnetic stimulation
- TRD, treatment-resistant depression
- VBM, voxel-based morphometry
- VN, vagus nerve
- VNS, vagus nerve stimulation
- VS, ventral striatum
- VTA, ventral tegmental area
- aCC, anterior cingulate cortex
- dTMS, deep transcranial magnetic stimulation
- daCC, dorsal anterior cingulate cortex
- dlPFC, dorsolateral prefrontal cortex
- fMRI, functional magnetic resonance imaging
- fNIRS, functional near-infrared spectroscopy
- lPFC, lateral prefrontal cortex
- pCC, posterior cingulate cortex
- rCBF, regional cerebral blood flow
- rTMS, repetitive transcranial magnetic stimulation
- rtfMRI, real-time functional magnetic resonance imaging
- tACS, transcranial alternate current stimulation
- tDCS, transcranial direct current stimulation
- tRNS, transcranial random noise stimulation
- vlPFC, ventrolateral prefrontal cortex
- vmH, ventromedial hypothalamus
- vmPFC, ventromedial prefrontal cortex
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Affiliation(s)
| | - E. Aarts
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - B. Weber
- Department of Epileptology, University Hospital Bonn, Germany
| | - M. Ferrari
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - V. Quaresima
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - L.E. Stoeckel
- Massachusetts General Hospital, Harvard Medical School, USA
| | - M. Alonso-Alonso
- Beth Israel Deaconess Medical Center, Harvard Medical School, USA
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