Disorders - Anorexia Nervosa
Tierney, S., Wyatt, K.
OBJECTIVE: To determine the effectiveness of psychosocial interventions for adolescents with AN. METHODS: An extensive and systematic literature search was conducted for randomised controlled trials (RCTs) addressing the effectiveness of psychosocial interventions for teenagers (11-18 years) with AN. RESULTS: Eight RCTs were located meeting the review's inclusion criteria, the majority of which focused on some form of family-related intervention. DISCUSSION: Unfortunately, a lack of robust primary research on which to base the review meant that clear recommendations could not be made. More good quality research, examining a range of interventions, and involving larger samples, is required before a similar systematic review is executed. [References: 43]
Eating & Weight Disorders, 10(2) : 66-75
- Year: 2005
- Problem: Anorexia Nervosa
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
Ball, Jillian, Mitchell, Philip
Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12- month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21-25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had "good" outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Eating Disorders, 12(4) : 303-314
- Year: 2004
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy
Pike, Kathleen M., Walsh, B., Vitousek, Kelly, Wilson, G., Bauer, Joy
OBJECTIVE: This study provides what the authors believe is the first empirical evaluation of cognitive behavior therapy as a posthospitalization treatment for anorexia nervosa in adults. METHOD: After hospitalization, 33 patients with DSM-IV anorexia nervosa were randomly assigned to 1 year of outpatient cognitive behavior therapy or nutritional counseling. RESULTS: The group receiving nutritional counseling relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy (53% versus 22%). The overall treatment failure rate (relapse and dropping out combined) was significantly lower for cognitive behavior therapy (22%) than for nutritional counseling (73%). The criteria for "good outcome" were met by significantly more of the patients receiving cognitive behavior therapy (44%) than nutritional counseling (7%). CONCLUSIONS: Cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse. To the authors' knowledge, these data provide the first empirical documentation of the efficacy of any psychotherapy, and cognitive behavior therapy in particular, in posthospitalization care and relapse prevention of adult anorexia nervosa. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
American Journal of Psychiatry, 160(11) : 2046-2049
- Year: 2003
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Relapse prevention
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Dietary advice, dietary change
Robb, A. S., Silber, T. J., Orrell-Valente, J. K., Valadez-Meltzer, A., Ellis, N., Dadson, M. J., Chatoor, I.
Objective: Although controversy exists regarding nasogastric refeeding for patients with anorexia nervosa, current methods of inpatient care often result in low discharge weight, a critical risk factor in relapse. This study compared the short-term outcomes of standard oral refeeding and supplemental nocturnal nasogastric refeeding. Method: Subjects were 100 hospitalized Caucasian adolescent girls who met DSMIV criteria for anorexia nervosa. Subjects were partitioned into two groups: oral refeeding(N=48, mean age=15.0 years, SD= 1.8) and nocturnal nasogastric refeeding (N=52, mean age=14.8 years, SD=1.9). Unpaired t tests, with Bonferroni correction, were used to compare groups at hospital admission and at discharge. Multivariate linear regression was used to establish the independent effects of nocturnal nasogastric refeeding after adjustment for potential confounding variables. Results: On admission, the groups were comparable in terms of age, weight, and other factors but differed significantly in number of prior hospitalizations (the nocturnal nasogastric refeeding group had more than the oral refeeding group). A series of separate multivariate linear regression models revealed that nocturnal nasogastric refeeding was a significant predictor of weight at discharge and absolute weight gain. Conclusions: Over a comparable period of time, patients treated with nocturnal nasogastric refeeding had a greater and more rapid weight gain than patients treated with traditional oral refeeding. Supplemental nocturnal nasogastric refeeding was more effective than oral refeeding alone in weight restoration during hospitalization. However, further study is needed on its short-term and long-term effectiveness.
American Journal of Psychiatry., 159(8) : 1347-1353
- Year: 2002
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Bergh, C., Brodin, U., Lindberg, G., Sodersten, P.
Evidence for the effectiveness of existing treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the control group (n = 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging (bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen patients went into remission after a median of 14.4 months (range 4.9-26.5) of treatment, but only one patient went into remission while waiting for treatment (P = 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months (quartile range 9.6 [greater-than or equal to]32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained in remission for 12 months (quartile range 6-36). Because the risk of relapse is maximal in the first year after remission, we suggest that most patients treated with this method recover.
Proceedings of the National Academy of Sciences of the United States of America., 99(14) : 9486-9491
- Year: 2002
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Fassino, Secondo, Leombruni, Paolo, Daga, Giovanni Abbate, Brustolin, Annalisa, Migliaretti, Giuseppe, Cavallo, Franco, Rovera, Giovanni G.
Anorexia nervosa (AN) still lacks a defined treatment. Since fluoxetine proved effective in weight-restored anorexics, this pilot study evaluates the efficacy of another SSRI, citalopram, in restricting-type AN. 52 female anorectic outpatients were randomized in the citalopram (n=26) and waiting list (n=26) as a control group. Efficacy was assessed using Eating Disorder Inventory-2 (EDI-2), Eating Disorder Inventory-Symptom Checklist, State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), Symptom Checklist-90 (SCL-90)and Structured Clinical Interview for DSM-IV Axis II Disorders. 13 patients dropped-out, thus 19 patients received citalopram and 20 remained in the control group. After 3 months of treatment, the citalopram group showed a decrease on BDI and SCL-90 Depression subscale and an improvement of baseline obsessive compulsive features on SCL-90, EDI-2 impulsiveness and Trait-anger on STAXI. Weight gain was similar in the two groups. These preliminary results support the efficacy of citalopram in anorectics. Citalopram seems to improve depression, obsessive-compulsive symptoms, impulsiveness and Trait-anger. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
European Neuropsychopharmacology, 12(5) : 453-459
- Year: 2002
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Dare, Chris, Eisler, Ivan, Russell, Gerald, Treasure, Janet, Dodge, Liz
Background Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.Aims To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.Method Eighty-four patients were randomised to four treatments: three specific psychotherapies — (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive—analytic therapy (CAT); (c) family therapy for 1 year — and (d) low contact, ‘routine’ treatment for 1 year (control).Results At 1 year, there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show benefits.Conclusions Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.
British Journal of Psychiatry, 178(3) : 216-221
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Family therapy, Psychodynamic/Psychoanalysis, Cognitive analytic therapy (CAT)
Ruggiero, G. M., Laini, V., Mauri, M. C., Ferrari, V. M. S., Clemente, A., Lugo, F., Mantero, M., Redaelli, G., Zappulli, D., Cavagnini, F.
1. The study evaluated the efficacy of amisulpride, fluoxetine and clomipramine at the beginning of the re-feeding phase of the treatment of restricting anorexia nervosa according to DSM-IV criteria. 2. 13 patients, mean weight 37.61 kg +/- 9.80 SD, were treated with clomipramine at a mean dosage of 57.69 mg +/- 25.79 SD; 10 patients, mean weight 40.90 kg +/- 6.98 SD, were treated with fluoxetine at a mean dosage of 28.00 mg +/- 10.32 SD; 12 patients, mean weight 38.41 kg +/- 8.33 SD, were treated with amisulpride at a mean dosage of 50.00 mg +/- 0.00 SD. 3. Clinical evaluation was carried out under single-blind condition at basal time and after three months by a structured clinical interview, the Eating Disorder Interview based on Long Interval Follow-up Evaluation (LIFE II BEI). 4. Patients treated with amisulpride showed a more significant increase (p=O.O16) of mean weight. Concerning weight phobia, body image disturbance and amenorrhoea, no significant difference resulted.
Progress in Neuro-Psychopharmacology & Biological Psychiatry., 25(5) : 1049-1059
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Atypical Antipsychotics (second generation)
Santonastaso, Paolo, Friederici, Silvia, Favaro, Angela
Conducted an open, controlled trial of sertraline in a sample of 11 restricting-type anorexics, treated in an outpatient setting, compared with a control group of patients with similar characteristics (all Ss aged 14-34 yrs). All Ss were assessed by means of a structured interview and self-reported questionnaires at baseline and after 14 wks of treatment. Body weight and diagnostic status were evaluated again after a 64-wk follow-up. At the 14-wk follow-up, the sertraline group reported a significantly greater improvement of depressive symptoms, ineffectiveness, lack of interoceptive awareness, and perfectionism when compared to the control group. Both groups reported a significant improvement in body weight. At the 64-wk follow-up, only 1 patient of the sertraline group and 5 patients of the control group still had a full diagnosis of an eating disorder. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Child & Adolescent Psychopharmacology, 11(2) : 143-150
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Kaye, Walter H., Nagata, Toshihiko, Weltzin, Theodore E., Hsu, L., Sokol, Mae S., McConaha, Claire, Plotnicov, Katherine H., Weise, Jeff, Deep, Dianne
Anorexia nervosa is an often chronic disorder with high morbidity and mortality. Many people relapse after weight restoration. This study was designed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms. The authors administered a double-blind placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa. Anorexics were randomly assigned to fluoxetine (n=16) or a placebo (n=19) after inpatient weight gain and then were observed as outpatients for 1 year. Ten of 16 (63%) Ss remained on fluoxetine for a year, whereas only three of 19 (16%) remained on the placebo for a year. Those Ss remaining on fluoxetine for a year had reduced relapse as determined by a significant increase in weight and reduction in symptoms. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Biological Psychiatry, 49(7) : 644-652
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Relapse prevention
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Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Eisler, Ivan, Dare, Christopher, Hodes, Matthew, Russell, Gerald, Dodge, Elizabeth, Le Grange, Daniel
Reports the results of a randomized treatment trial of 2 forms of outpatient family intervention for anorexia nervosa. 40 adolescent patients (aged 11-17 yrs) with anorexia nervosa were randomly assigned to conjoint family therapy (CFT) or to separated family therapy (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index. Measures were undertaken on admission to the study, at 3 mo, at 6 mo, and at the end of treatment. Considerable improvement in nutritional and psychological state occurred across both treatment groups. On global measure of outcome, the 2 forms of therapy were associated with equivalent end of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between parents increased. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Child Psychology & Psychiatry, 41(6) : 727-736
- Year: 2000
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Family therapy
Geist, R., Heinmaa, M., Stephens, D., Davis, R., Katzman, D. K.
OBJECTIVE: To compare the effects of 4 months of 2 family-oriented treatments, family therapy and family psychoeducation, on female adolescents with newly diagnosed restrictive eating disorders. METHOD: Twenty-five female adolescents requiring hospitalization were randomized into either family therapy or family group psychoeducation. Outcome measures included medical (body weight) and psychosocial (specific and nonspecific eating disorder psychopathology) variables at baseline and after 4 months of treatments every 2 weeks. RESULTS: A significant time effect was found in both treatment groups for the restoration of body weight (percentage of ideal body weight, P < 0.00001). The group averages ranged from 75% to 77% ideal body weight before treatment to 91% to 96% after it. A time effect was also seen on the Family Assessment Measure (P < 0.018), in that the patients of both groups acknowledged more family psychopathology at the end of treatment. No significant group differences were found on any of the self-report measures of specific and nonspecific eating disorder pathology. CONCLUSIONS: Weight restoration was achieved following the 4-month period of treatment in both the family therapy and family psychoeducation groups, but no significant change was reported in psychological functioning by either adolescents or parents. Family group psychoeducation, the less expensive form of treatment, is an equally effective method of providing family-oriented treatment to newly diagnosed, medically compromised anorexia nervosa patients and their families.
Canadian Journal of Psychiatry, 45(2) : 173-8
- Year: 2000
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Family therapy, Psychoeducation