Disorders - Anorexia Nervosa
Flament, Martine F., Bissada, Hany, Spettigue, Wendy
The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.;
International Journal of Neuropsychopharmacology, 15(2) : 189-207
- Year: 2012
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
Faje, Alexander T., Fazeli, Pouneh K., Katzman, Debra K., Miller, Karen K., Breggia, Anne, Rosen, Clifford J., Mendes, Nara, Klibanski, Anne, Misra, Madhusmita
Sclerostin, product of the SOST gene, is an important determinant of bone formation and resorption. Adolescents with anorexia nervosa (AN) have low bone density and decreased levels of bone turnover markers. However, sclerostin has not been examined in AN as a potential mediator of impaired bone metabolism. Our study objectives were to (i) assess associations of sclerostin with surrogate bone turnover markers in girls with AN and controls and (ii) examine effects of transdermal estradiol on sclerostin in AN. 69 girls (44 with AN and 25 normal-weight controls) 13-18 years old were studied at baseline. 22 AN girls were randomized to transdermal estradiol (plus cyclic medroxyprogesterone) or placebo in a double-blind study for 12 months. Sclerostin correlated positively with P1NP and CTX in controls (r=0.67 and 0.53, p=0.0002 and 0.005, respectively) but not in AN despite comparable levels at baseline. Changes in sclerostin over twelve months did not differ in girls randomized to estradiol or placebo. The relationship between sclerostin and bone turnover markers is disrupted in adolescent girls with AN. Despite an increase in BMD with estradiol administration in AN, estrogen does not impact sclerostin levels in this group.; Copyright © 2012 Elsevier Inc. All rights reserved.
Bone, 51(3) : 474-479
- Year: 2012
- 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)
, Other biological interventions
Faje, A. T., Fazeli, P., Katzman, D. K., Miller, K. K., Breggia, A., Rosen, C. J., Mendes, N., Misra, M., Klibanski, A.
Regulation of mesenchymal stem cell (MSC) differentiation into the osteoblast or the adipocyte lineage may influence bone formation. Adolescents with anorexia nervosa (AN) have low bone mineral density (BMD) and decreased bone formation. Preadipocyte factor 1 (Pref-1), an inhibitor of adipocyte and osteoblast differentiation, is elevated in states of estrogen deficiency and may negatively affect BMD in adolescent girls with AN.Objective: To (i) compare levels of Pref-1 in adolescent girls with AN and controls, (ii) investigate the effects of transdermal estradiol on Pref-1 in AN, and (iii) examine associations of changes in Pref-1 with changes in lumbar BMD and markers of bone turnover.Design and Methods: Sixty-nine girls (44 with AN and 25 normal-weight controls) 13-18 years of age were studied at baseline. Subjects were selected from a prior study based on their lumbar spine BMD Z-scores. The subset included all subjects with AN who had a baseline lumbar BMD Z-score less than -0.5 and normal-weight controls with lumbar BMD Z-scores between +1.0 and -1.0. Twenty-two AN girls with a bone age of (greater-than or equal to) 15 years were randomized to 100mcg transdermal estradiol (n = 13) or placebo (n = 9) in a double-blind study for 12 months. Subjects randomized to transdermal estradiol received medroxyprogesterone 2.5mg daily for 10 days each month. All subjects also received calcium carbonate (1200mg) and vitamin D (400 IU) daily. Results: Although Pref-1 levels did not differ in AN versus controls (0.246 (plus or minus) 0.015 vs. 0.267 (plus or minus) 0.022 ng/ml, p = 0.46) at baseline, levels significantly decreased in girls with AN after treatment with transdermal estradiol compared with placebo (-0.015 (plus or minus) 0.016 vs. 0.060 (plus or minus) 0.026 ng/ml, p = 0.02). Changes in Pref-1 over twelve months correlated inversely with changes in lumbar BMD (r = -0.48, p = 0.02) and positively with changes in CTX (r = 0.73, p = 0.01). Levels of Pref-1 were inversely associated with estradiol levels in subjects with AN (r = -0.67, p = 0.004) after 12 months of treatment with transdermal estradiol or placebo. Conclusion s: One year of estrogen replacement suppresses Pref-1 in girls with AN. Additionally, Pref-1 levels correlate inversely with changes in BMD and positively with changes in CTX, a marker of bone resorption. Inhibition of Pref-1 may in part mediate the beneficial effects of transdermal estradiol replacement on bone mass in adolescent girls with AN.
Endocrine Reviews, 33(3) :
- Year: 2012
- 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)
, Other biological interventions
Divasta, Amy D., Feldman, Henry A., Giancaterino, Courtney, Rosen, Clifford J., Leboff, Meryl S., Gordon, Catherine M.
Anorexia nervosa (AN) is characterized by subnormal estrogen and dehydroepiandrosterone (DHEA) levels. We sought to determine whether the combination of DHEA + estrogen/progestin is superior to placebo in preserving skeletal health over 18 months in AN. Females with AN, aged 13 to 27 years, were recruited for participation in this double-blind, placebo-controlled, randomized trial. Ninety-four subjects were randomized, of whom 80 completed baseline assessments and received either study drug (oral micronized DHEA 50 mg + 20 µg ethinyl estradiol/0.1 mg levonorgestrel combined oral contraceptive pill [COC] daily; n = 43) or placebo (n = 37). Serial measurements of areal bone mineral density (aBMD), bone turnover markers, and serum hormone concentrations were obtained. Sixty subjects completed the 18-month trial. Spinal and whole-body aBMD z scores were preserved in the DHEA + COC group, but decreased in the placebo group (comparing trends, P = .008 and P = .001, respectively). Bone turnover markers initially declined in subjects receiving DHEA + COC and then returned to baseline. No differences in body composition, adverse effects of therapy, or alterations in biochemical safety parameters were observed. Combined therapy with DHEA + COC appears to be safe and effective for preventing bone loss in young women with AN, whereas placebo led to decreases in aBMD. Dehydroepiandrosterone + COC may be safely used to preserve bone mass as efforts to reverse the nutritional, psychological, and other hormonal components of AN are implemented.; Copyright © 2012 Elsevier Inc. All rights reserved.
Metabolism: Clinical & Experimental, 61(7) : 1010-1020
- Year: 2012
- 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)
, Other biological interventions
Stiles-Shields, C., Smyth, A., Glunz, C., Hoste, R. R., Boepple, L., le Grange, D.
Eating disorders frequently have their onset in adolescence. This is problematic as Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS) often present with serious psychiatric and medical sequelae that can affect an adolescent's physical and emotional development. It is well documented that complications from eating disorders in adolescence can result in long-term health consequences, rendering effective psychiatric and medical treatments a necessity. To combat the medical consequences associated with eating disorders in adolescents, pediatricians must identify, treat, and monitor medical complications. Pediatricians are also responsible for assessing the need for hospitalization due to medical instability. Some advances have been made regarding psychopharmacological treatments for eating disorders. For example, antidepressant medications, such as SSRIs, have demonstrated efficacy in the treatment of adults with BN. The true effectiveness of these medications in adolescent populations remains unknown. A multidisciplinary team approach is a common treatment model in outpatient practice, but further research is required to investigate how to facilitate the collaboration of psychiatric and medical professionals. The majority of psychiatric and medical trials for eating disorder patients have involved adult participants, and most studies have investigated either psychiatric or medical treatments for eating disorders. In this review, we will add to the current literature by focusing on both psychiatric and medical treatments for eating disorders, with particular emphasis on studies conducted with adolescents. (copyright) 2011 Bentham Science Publishers.
Current Psychiatry Reviews, 7(3) : 177-188
- Year: 2011
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
Smith, A., Cook-Cottone, C.
This review examines family therapy as an effective intervention for Anorexia Nervosa (AN) in adolescents. An electronic and manual literature search was conducted. Studies pertaining to family therapy in the treatment of AN and specifically, the Maudsley Method/ Family-Based Treatment were identified. A limited number of randomized control trials exist implicating family therapy. Of the existent studies, methodological limitations pertaining to small, homogeneous sample sizes are evident. Despite the limited number of studies, family therapy appears to illustrate probable efficacy. Additional research and funding are necessary to fully support family therapy in the treatment of AN in adolescents. (copyright) Springer Science+Business Media, LLC 2011.
Journal of Clinical Psychology in Medical Settings, 18(4) : 323-334
- Year: 2011
- 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)
, Family therapy
Wick, K., Brix, C., Bormann, B., Sowa, M., Strauss, B., Berger, U.
Objective: Anorexia nervosa ('AN') is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program ('PriMa') for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls. Method: Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n=1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge. Results: After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d=.24) and body self esteem (d=.29), but not for eating behavior. Conclusion: The PriMa intervention provides an efficient and practical model to increase AN-related protection factors. (copyright) 2010 Elsevier Inc.
Preventive Medicine, 52(2) : 152-158
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
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Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Hagman, J.: Gralla, J., Sigel, E., Ellert, S., Dodge, M., Gardner, R., O'Lonergan, T., Frank, G., Wamboldt, M. Z.
The purpose of this double-blind, placebo-controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa. Forty female subjects 12 to 21 years of age (mean, 16 years) with primary anorexia nervosa in an eating disorders program were randomized to receive risperidone (n = 18) or placebo (n = 22). Subjects completed the Eating Disorder Inventory 2, Color-A-Person Test, Body Image Software, and Multidimensional Anxiety Scale for Children at baseline and regular intervals. Weight, laboratory values, and electrocardiograms were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint. The mean dose for the risperidone group was 2.5 mg and for the placebo group was 3 mg for a mean duration of 9 weeks. Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2 Drive for Thinness subscale over the first 7 weeks (effect size, 0.88; p = .002), but this difference was not sustained to the end of the study (p = .13). The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone (effect size, 0.60; p = .03). Subjects taking risperidone had increased prolactin levels (week 7; p = .001). There were no significant differences between groups at baseline or the end of the study for the other rating scales, change in weight, or laboratory measurements. This study does not demonstrate a benefit for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care. Clinical trial registration information-A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa, http://www.clinicaltrials.gov, NCT00140426. Copyright (copyright) 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent Psychiatry, 50(9) : 915-924
- Year: 2011
- 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)
, Atypical Antipsychotics (second generation)
Kafantaris, V., Leigh, E., Hertz, S., Berest, A., Schebendach, J., Sterling, W. M., Saito, E., Sunday, S., Higdon, C., Golden, N. H., Malhotra, A. K.
Objective: The objective of this study was to explore whether the addition of olanzapine versus placebo increases weight gain and improves psychological symptoms in adolescents with anorexia nervosa-restricting type who are participating in a comprehensive eating disorders treatment program. Methods: Twenty underweight females participated in this 10-week, double-blind, placebo-controlled pilot study of olanzapine. The primary efficacy measure was change in percentage of median body weight measured at baseline and weeks 5 and 10. Secondary efficacy measures included clinician-rated and self-reported measures of psychological functioning measured at 2-week intervals and eating disorder symptoms measured at baseline and weeks 5 and 10 as well as laboratory assessments (including indirect calorimetry), which were also performed at baseline and weeks 5 and 10. A mixed models approach to repeated measures analysis of variance was utilized to detect any treatment-by-time interaction. Results: Fifteen of 20 enrolled females (median age, 17.1 years; range, 12.3-21.8 years; mean body mass index, 16.3) completed this 10-week pilot study. Change in % median body weight did not differ between the treatment groups at midpoint or end of study. Both groups gained weight at a similar rate and had similar improvements in eating attitudes and behaviors, psychological functioning, and resting energy expenditure. A trend of increasing fasting glucose and insulin levels was found only in the olanzapine group at week 10. Conclusions: These preliminary findings do not support a role for adjunctive olanzapine for underweight adolescent females with anorexia nervosa-restricting type who are receiving standard care in an eating disorder treatment program (copyright) 2011, Mary Ann Liebert, Inc.
Journal of Child & Adolescent Psychopharmacology, 21(3) : 207-212
- Year: 2011
- 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)
, Atypical Antipsychotics (second generation)
Gardner, J., Wilkinson, P.
Introduction: Anorexia nervosa is a mental health disorder characterised by deliberate weight loss (through restrictive eating, excessive exercise and/or purging), disordered body image, and intrusive overvalued fears of gaining weight. The National Institute for Clinical Excellence recommends that family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa. Aims: To perform a literature review to assess whether family therapy is a more effective intervention than other treatments in the management of adolescents with anorexia nervosa. Method: Search of PubMed, The Cochrane Library and NHS Evidence for randomised controlled trials that compared a family intervention with another treatment for anorexia nervosa in adolescence. Results and discussion: This literature search revealed only six randomised controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients. Due to the small sample sizes and the significant risk of bias (particularly information bias) in some of the studies the evidence in favour of family therapy over individual therapy is weak. In the future, larger randomised controlled trials with long term follow-up are required to assess whether family therapy is the most effective treatment for anorexia nervosa in adolescence. (copyright) Medicinska naklada.
Psychiatria Danubina, 23(SUPPL. 1) : S175-S177
- Year: 2011
- 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)
, Family therapy
Hartmann, Armin, Weber, Stefanie, Herpertz, Stephan, Zeeck, Almut
Background: Methods: Results: Conclusion: For the German treatment guidelines for eating disorders, the literature on psychological treatment of anorexia nervosa (AN) was reviewed systematically. As a common meta-analysis of randomized clinical trials proved to be impossible, a review of all available clinical trials was conducted, statistically integrating standardized mean change scores. Research questions comprised differential effects of therapeutic techniques and settings as well as determining which weight gains could be expected.After an extensive literature search, studies were selected, rated by 3 independent raters. Weight gain as the main outcome criterion was transformed into standardized mean change scores. Effect sizes were checked for homogeneity.57 studies containing 84 treatment arms and 2,273 patients could be integrated. Studies differed considerably in quality. The strongest bias identified was reporting selectively on completers or failures, versus intention-to-treat samples. No significant differences between effect sizes could be identified concerning treatment setting, technique or patient characteristics. If treatment time is taken into account, inpatient treatment produced a faster weight gain than outpatient treatment.The study describes weight gains which can be reached in outpatient and inpatient settings. It yielded no salient results speaking for a certain therapy technique, setting or procedure. Treatment guidelines for psychological treatment of AN still have to rely on lower level evidence.
Copyright © 2011 S. Karger AG, Basel.
Psychotherapy & Psychosomatics, 80(4) : 216-226
- Year: 2011
- 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)
Lock, James, Le Grange, Daniel, Agras, W. Stewart, Moye, Ann, Bryson, Susan W., Jo, Booil
Context: Objective: Design: Setting: Participants: Main Outcome Measures: Results: Conclusion: Trial Registration: Evidence-based treatment trials for adolescents with anorexia nervosa are few.To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.Randomized controlled trial.Stanford University and The University of Chicago (April 2005 until March 2009).One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology.There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up.Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points.clinicaltrials.gov Identifier: NCT00149786.
Archives of General Psychiatry, 67(10) : 1025-1032
- Year: 2010
- 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, Other Psychological Interventions