Disorders - Anorexia Nervosa
Harrison, A., Stavri, P., Ormond, L., McEnemy, F., Akyol, D., Qureshi, A., Al-Khairulla, H.
Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whether individual and group CRT was a feasible, acceptable, and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age = 15.22, SD = 1.44) received 10 sessions of individual CRT, and 55 patients (mean age = 14.89, SD = 1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out, and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills, and large-sized improvements in motivation to recover. Group CRT had higher dropout (9.09%; n = 5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest that a randomised controlled trial for adolescents with AN is warranted. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 26(3) : 230-240
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive remediation therapy, Other service delivery and improvement interventions
Pegado, P., Alckmin-Carvalho, F., Leme, D., Carneiro, F., Kypriotis, P., Camacho, P., Fleitlich-Bilyk, B.
Background: Most of the clinical trials involving cognitive-behavioral therapy (CBT) for the treatment of anorexia nervosa (AN) used the individual therapy format, and few have been dedicated to adapting and assessing the effects of the group format. Objectives: To assess the applicability and effects of a group CBT program for Brazilian adolescents with AN. Methods: Open clinical trial with 22 patients with AN divided into an intervention group - IG (n = 11; CBT, psychiatry, nutrition and family psychoeducation-6 months) and a control group - CG (n = 11; psychiatry, nutrition and family psychoeducation-6 months). Data collected at baseline, at the end of groups and six months after the completion were: weight, height, body mass index and Eating Disorder Examination Questionnaire (EDE-Q) used to assess the severity of AN symptoms. Results: Baseline homogeneous groups, with 91% adherence in the IG vs. 54% in the CG (p = 0.05). Participants in both groups regained weight and decreased symptoms of eating disorders at the end of groups. Comparing the EDE-Q scores IG presented a statistically significant difference in the restraint subscale of the EDE-Q between the end-of-group and the follow-up (p = 0.01). Discussion: Group CBT program produced positive effects and was applicable in Brazilian adolescents with AN as an adjuvant to multidisciplinary treatment. Copyright © 2018, Universidade de Sao Paulo. All rights reserved.
Revista de Psiquiatria Clinica, 45(3) : 57-60
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Spettigue, W., Norris, M. L.
Objectives: To evaluate the effectiveness and safety of adjunctive olanzapine treatment for low weight adolescents with anorexia nervosa (AN). Methods: A non-randomized open-label trial was conducted between 2010 and 2014. Participants received standard treatment and were invited to take olanzapine at study enrollment. Participants could accept, continue, or discontinue olanzapine as treatment progressed. Weight and psychological outcomes were monitored. Results: Of 239 adolescents assessed, 65 met inclusion criteria, 38 enrolled in the study, and 32 were retained for analysis. Twenty-two participants took olanzapine (medication group) and ten participants did not (comparison group). Participants in the medication group demonstrated a higher rate of weight gain compared to those who did not receive olanzapine (p =.012). No serious adverse events were noted, although seven participants (31.8%) discontinued olanzapine due to a side effect. Conclusion: Preliminary results suggest that olanzapine may help facilitate weight gain in adolescents with AN. The importance of medical monitoring over the course of treatment is discussed. Evaluation of the Efficacy and Safety of Olanzapine for Anorexia Nervosa in Children and Adolescents; http://clinicaltrials.gov; NCT01184443. Copyright © 2018, Canadian Academy of Child and Adolescent Psychiatry. All rights reserved.
Journal of the Canadian Academy of Child & Adolescent Psychiatry, 27(3) : 197-208
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Jaite, C., Pfeiffer, E., Thurn, C., Lehmkuhl, U., Salbach, H.
Introduction.- The knowledge on baseline predictors that influence treatment outcome in adolescents with eating disorders is quite limited. This study aimed to determine predictors of treatment outcome in adolescent outpatients with anorexia nervosa (AN). Methods.- The sample included 81 adolescent patients (Mage = 16.9, SDage = 1.8) with AN according to DSM-IV. Patients were randomly assigned to either 25 weeks of CBT or 25 weeks of DBT. Before (T0) and after treatment (T1) the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX), the Eating Disorder Inventory-2 (EDI-2) and the Symptom-Checklist-90-R of Derogatis (SCL-90-R) were applied. For each participant body height (m) and body weight (kg) were measured to calculate the body mass index (BMI) and the BMI percentile. The following baseline variables were examined as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, eating disorder-specific and general psychopathology as well as treatment group (CBT/DBT). Linear regression analyses were conducted to identify the predictors of the BMI and the EDI global score at the end of treatment. Results.- A higher BMI (p = .048), a lower age (p = .018), and a lower eating disorder-specific psychopathology (p = .004) were associated with a better outcome at the end of outpatient treatment. The other studied predictors showed no prognostic impact on the treatment outcome. Conclusions.- Further research is necessary to investigate whether patients with severe AN might benefit from specific treatment approaches.
European Psychiatry, 48 (Supplement 1) : S419
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Dialectical behavioural therapy (DBT)
Keizer, A., Engel, M. M., Bonekamp, J., Van-Elburg, A.
Purpose: We tested in a pilot study a new intervention for body image disturbance in anorexia nervosa (AN). Unlike common treatment approaches our hoop training targeted not only cognitive-emotional and visual aspects of body image, but also tactile and body-scaled action components. Methods: We assessed cognitive, visual, tactile and body-scaled action aspects of body image disturbance before and after completion of hoop training. Twelve AN patients completed treatment as usual (TAU) for body image, 14 completed hoop training in addition to TAU. Results: Results show that patients who completed the 8-week individual hoop training in addition to TAU improved more on body image disturbance tasks from baseline to follow-up than patients who completed only TAU. Hoop training specifically seems to affect tactile body image and body-scaled action. Conclusions: Taken together, a treatment approach in which the full spectrum of body image disturbances in AN is targeted has a unique added effect over treatment as usual. Level of evidence: Level II, non-randomized controlled study. Copyright © 2018, The Author(s).
Eating and Weight Disorders., :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Kelly, A. C., Waring, S. V.
Objective: Most individuals with anorexia nervosa (AN) do not seek treatment and shame is a common barrier. This study sought to determine whether a brief intervention designed to foster self-compassion would reduce shame and increase treatment motivation among nontreatment seeking individuals with AN. Method: Forty nontreatment seeking females with AN (75%) and atypical AN were randomly assigned to 2 weeks of a daily self-compassionate letter-writing intervention or a waitlist control condition. All participants completed pre, mid, and post questionnaires, and were weighed pre and post. Results: The intervention yielded respectable credibility ratings and compliance and retained 95% of participants. Compared to the control condition, it produced greater increases in self-compassion and greater decreases in shame and fears of self-compassion. BMI and readiness to get help for one's eating decreased in the control condition but did not change significantly in the intervention condition, though the motivation for treatment showed a trend toward increasing. Changes in eating pathology and readiness to get help for one's weight did not differ between conditions. Discussion: Self-compassionate letter-writing may be an acceptable and feasible intervention for nontreatment seeking individuals with AN and might reduce certain barriers to help-seeking while improving psychological functioning. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders., :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Nyman-Carlsson, E., Birgegard, A., Engstrom, I., Gustafsson, S. A., Nevonen, L.
Objective: The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome. Methods: Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology. Results: In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms. Conclusions: Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review., :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy
Russell, J., Maguire, S., Hunt, G. E., Kesby, A., Suraev, A., Stuart, J., Booth, J., McGregor, I. S.
Background: Nutritional rehabilitation in anorexia nervosa (AN) is impeded by fear of food, eating and change leading to treatment resistance. Oxytocin (OT) exerts prosocial effects and modulates trust, fear, anxiety and neuroplasticity. The current placebo-controlled RCT examined the effects of intranasal oxytocin (IN-OT) in AN. The aim was to ascertain whether repeated doses of IN-OT enhance treatment outcomes in AN. Methods: AN patients self-administered 36 IU IN-OT or placebo daily for 4-6 weeks during hospital treatment. The outcome measures were change in the Eating Disorders Examination (EDE) scale, weight gain, cognitive rigidity, social anxiety, obsessive and autistic symptoms. The effects of the first and last doses of IN-OT were assessed relative to placebo before and after a high-energy afternoon snack, to determine potential dampening of cortisol and anxiety levels by OT. Results: Weight gain was similar in both groups. The EDE eating concern subscale score was significantly lower after IN-OT treatment as was cognitive rigidity. There were no significant differences in social anxiety or any of the other outcomes at follow-up. After four weeks IN-OT, salivary cortisol levels were significantly lowered in anticipation of an afternoon snack compared to placebo. Morning plasma OT levels did not change after chronic IN-OT or with weight restoration. Conclusion: IN-OT might enhance nutritional rehabilitation in AN by reducing eating concern and cognitive rigidity. Lower salivary cortisol levels in response to IN-OT suggest diminished neuroendocrine stress responsiveness to food and eating. Such effects require replication with inclusion of more sensitive subjective measures. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Psychoneuroendocrinology, 87 : 83-92
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Vajapeyam, S., Ecklund, K., Mulkern, R. V., Feldman, H. A., O'Donnell, J. M., DiVasta, A. D., Rosen, C. J., Gordon, C. M.
Purpose: Dehydroepiandrosterone (DHEA) + estrogen/progestin therapy for adolescent girls with anorexia nervosa (AN) has the potential to arrest bone loss. The primary aim of this study was to test the effects of DHEA + estrogen/progestin therapy in adolescent girls with AN on bone marrow in the distal femur using magnetic resonance imaging (MRI) and spectroscopy. Methods: Seventy adolescent girls with AN were enrolled in a double blind, randomized, placebo-controlled trial at two urban hospital-based programs. Intervention: Seventy-six girls were randomly assigned to receive 12 months of either oral micronized DHEA or placebo. DHEA was administered with conjugated equine estrogens (0.3 mg daily) for 3 months, then an oral contraceptive (20 mug ethinyl estradiol/ 0.1 mg levonorgestrel) for 9 months. The primary outcome measure was bone marrow fat by MRI and magnetic resonance spectroscopy (MRS). Results: T2 of the water resonance dropped significantly less in the active vs. placebo group over 12 months at both the medial and lateral distal femur (p = 0.02). Body mass index (BMI) was a significant effect modifier for T1 and for T2 of unsaturated (T2unsat) and saturated fat (T2sat) in the lateral distal femur. Positive effects of the treatment of DHEA + estrogen/progestin were seen primarily for girls above a BMI of about 18 kg/m2. Conclusions: These findings suggest treatment with oral DHEA + estrogen/progestin arrests the age- and disease-related changes in marrow fat composition in the lateral distal femur reported previously in this population. Copyright © 2018
Bone, 110 : 335-342
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Alckmin-Carvalho, F., Vega, J. B., Cobelo, A. W., Fabbri, A. D., Pinzon, V. D., da-Silva-Melo, M. H.
Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive. Copyright © 2018, Universidade de Sao Paulo. All rights reserved.
Revista de Psiquiatria Clinica, 45(2) : 41-48
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Psychodynamic/Psychoanalysis, Acceptance & commitment therapy (ACT)
Richards, I. L., Subar, A., Touyz, S., Rhodes, P.
OBJECTIVE: To systematically review the literature reporting outcomes of augmentative family-based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs).
METHOD: Articles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database).
RESULTS: Thirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end-of-treatment, although few compared augmentative and standard FBT interventions and good quality follow-up data was generally lacking.
CONCLUSIONS: There is early evidence for the effectiveness of augmentative FBT-based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 26(2) : 92-111
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Rizzo, S. M., Douglas, J. W., Lawrence, J. C.
Weight restoration is an important first step in treating patients with anorexia nervosa (AN), because it is essential for medical stabilization and reversal of long-term complications. Tube feeding may help facilitate weight restoration, but its role in treatment remains unclear. This study aimed to review the literature describing the efficacy, safety, tolerance, and long-term effects of nasogastric (NG) refeeding for patients with AN. Four electronic databases were systematically searched through May 2018. Boolean search terms included "anorexia nervosa," "refeeding," and "nasogastric tube feeding." Ten studies were eligible for inclusion: 8 retrospective chart reviews, 1 prospective cohort, and 1 randomized controlled trial. Nine of the studies were performed in-hospital. In 8 studies, NG nutrition resulted in an average rate of weight gain exceeding 1 kg/wk. In 4 of 5 studies including an oral-only control group, mean weekly weight gain and caloric intake were significantly higher in tube-fed patients. Six studies provided prophylactic phosphate supplementation, all with <1% occurrence rate of refeeding hypophosphatemia. Seven studies reported on other physiological disturbances, 6 evaluated medical and gastrointestinal side effects, 3 considered psychological outcomes, and 4 assessed patients postdischarge. Results indicated that NG feeding was not associated with an increased risk for adverse outcomes. Overall, in these studies, NG nutrition was considered safe and well tolerated, and effectively increased caloric intake and rate of weight gain in patients with AN. However, results are limited by weaknesses in study designs, and more rigorous methods are needed for development of evidence-based, standardized refeeding protocols. Copyright © 2018 American Society for Parenteral and Enteral Nutrition
Nutrition in Clinical Practice, :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions