Disorders - Anorexia Nervosa
McKnight, Rebecca F., Park, Rebecca J.
Background: Aims: Method: Results: Conclusions: There is currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN).To evaluate the literature on the use of atypical antipsychotics in AN.A review of all studies and clinical guidelines published before September 2009 involving use of an atypical antipsychotic in patients with AN. Analysis is by narrative synthesis.Forty-three publications or study protocols were found, including four randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this setting.Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to persuade adequate numbers of AN patients to participate in research trials.
European Eating Disorders Review, 18(1) : 10-21
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
delValle, Maria Fernandez, Perez, Margarita, Santana-Sosa, Elena, Fiuza-Luces, Carmen, Bustamante-Ara, Natalia, Gallardo, Cristian, Villasenor, Angel, Graell, Montserrat, Morande, Gonzalo, Romo, Gabriel R., Lopez-Mojares, Luis M., Ruiz, Jonatan R.
Purpose: Methods: Results: Conclusions: We determined the effects of a 3-month low-moderate-intensity strength training program (2 sessions/week) on functional capacity, muscular strength, body composition, and quality of life (QOL) in 22 young (12-16 yrs) anorexic outpatients.Patients were randomly assigned to a training or control group (n=11 [10 females] each). Training sessions were of low intensity (loads for large muscle groups ranging between 20%-30% and 50%-60% of six repetitions maximum [6RM] at the end of the program). We measured functional capacity by the time up and go and the timed up and down stairs tests. Muscular strength was assessed by 6RM measures for seated bench and leg presses. We estimated percent body fat and muscle mass. We assessed patients' QOL with the Short Form-36 items.The intervention was well tolerated and did not have any deleterious effect on patients' health, and did not induce significant losses in their body mass. The only studied variable for which a significant interaction (group x time) effect was found (p=.009) was the 6RM seated lateral row test.Low-moderate-intensity strength training does not seem to add major benefits to conventional psychotherapy and refeeding treatments in young anorexic patients.; Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.
Journal of Adolescent Health, 46(4) : 352-358
- 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: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Court, A., Mulder, C., Kerr, M., Yuen, H. P., Boasman, M., Goldstone, S., Fleming, J., Weigall, S., Derham, H., Huang, C., McGorry, P., Berger, G.
To investigate the safety and tolerability of the atypical antipsychotic quetiapine in anorexia nervosa patients, and to determine the effect of quetiapine treatment on anorexic psychopathology and other key outcome measures including weight and body image, we conducted a naturalistic, open-label, 12-week randomized controlled trial of low-dose (100-400 mg/day) quetiapine treatment versus treatment as usual in 33 anorexia nervosa patients from our Eating Disorder Clinics. To monitor the effects of treatment over the medium term, the participants were then followed up with assessment visits at 6 and 12 months after the end of the treatment phase. Low-dose quetiapine treatment resulted in both psychological and physical improvements, with minimal associated side-effects. Given the overall trend toward improvement that we observed, quetiapine appears to be a promising candidate for the treatment of anorexia nervosa. Further large-scale placebo-controlled clinical trials will be necessary to fully evaluate the benefits of quetiapine treatment for this disorder. (copyright) 2010 Elsevier Ltd.
Journal of Psychiatric Research, 44(15) : 1027-1034
- 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: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Gowers, S. G., Clark, A. F., Roberts, C., Byford, S., Barrett, B., Griffiths, A., Edwards, V., Bryan, C., Smethurst, N., Rowlands, L., Roots, P.
Objective: Design: Setting: Participants: Interventions: Main Outcome Measures: Results: Conclusion: Trial Registration: To evaluate the clinical effectiveness and cost-effectiveness of inpatient compared with outpatient treatment and general (routine) treatment in Child and Adolescent Mental Health Services (CAMHS) against specialist treatment for young people with anorexia nervosa. In addition, to determine young people's and their carers' satisfaction with these treatments.A population-based, pragmatic randomised controlled trial (RCT) was carried out on young people age 12 to 18 presenting to community CAMHS with anorexia nervosa.Thirty-five English CAMHS in the north-west of England co-ordinated through specialist centres in Manchester and Liverpool.Two hundred and fifteen young people (199 female) were identified, of whom 167 (mean age 14 years 11 months) were randomised and 48 were followed up as a preference group.Randomised patients were allocated to either inpatient treatment in one of four units with considerable experience in the treatment of anorexia nervosa, a specialist outpatient programme delivered in one of two centres, or treatment as usual in general community CAMHS. The outpatient programmes spanned 6 months of treatment. The length of inpatient treatment was determined on a case-by-case basis on clinical need with outpatient follow-up to a minimum of 6 months.Follow-up assessments were carried out at 1, 2 and 5 years. The primary outcome measure was the Morgan-Russell Average Outcome Scale (MRAOS) and associated categorical outcomes. Secondary outcome measures included physical measures of weight, height, body mass index (BMI) and % weight for height. Research ratings included the Health of the National Outcome Scale for Children and Adolescents (HoNOSCA). Self report measures comprised the user version of HoNOSCA (HoNOSCA-SR), the Eating Disorder Inventory 2 (EDI-2), the Family Assessment Device (FAD) and the recent Mood and Feelings Questionnaire (MFQ). Information on resource use was collected in interview at 1, 2 and 5 years using the Child and Adolescent Service Use Schedule (CA-SUS). Satisfaction was measured quantitatively using a questionnaire designed for the study and qualitative (free) responses on it. The questionnaire data were supplemented by qualitative analysis of user and carer focus groups.Of the 167 patients randomised, 65% adhered to the allocated treatment. Adherence was lower for inpatient treatment (49%) than for general CAMHS (71%) or specialist outpatient treatment (77%) (p = 0.013). Every subject was traced at both 1 and 2 years, with the main outcome measure completed (through contact with the subject, family members or clinicians), by 94% at 1 year, 93% at 2 years, but only 47% at 5 years. A validated outcome category was assigned for 98% at 1 year, 96% at 2 years and 60% at 5 years. There was significant improvement in all groups at each time point, with the number achieving a good outcome being 19% at 1 year, 33% at 2 years and 64% (of those followed up) at 5 years. Analysis demonstrated no difference in treatment effectiveness of randomisation to inpatient compared with outpatient treatment, or, specialist over generalist treatment at any time point, when baseline characteristics were taken into account. Generalist CAMHS treatment was slightly more expensive over the first 2 years of the study, largely because greater numbers were subsequently admitted to hospital after the initial treatment phase. The specialist outpatient programme was the dominant treatment in terms of incremental cost-effectiveness. Specialist treatments had a higher probability of being more cost-effective than generalist treatments and outpatient treatment had a higher probability of being more cost-effective than inpatient care. Parental satisfaction with treatment was generally good, though better with specialist than generalist treatment. Young people's satisfaction was much more mixed, but again better with specialist treatment, including inpatient care.Poor adherence to randomisation ( espite initial consent to it), limits the assessment of the treatment effect of inpatient care. However, this study provides little support for lengthy inpatient psychiatric treatment on clinical or health economic grounds. These findings are broadly consistent with existing guidelines on the treatment of anorexia nervosa, which suggest that outpatient treatments should be offered to the majority, with inpatient treatment offered in rare cases, though our findings lend little support to a stepped-care approach in which inpatient care is offered to outpatient non-responders. Outpatient care, supported by brief (medical) inpatient management for correction of acute complications may be a preferable approach. The health economic analysis and user views both support NICE guidelines, which suggest that anorexia nervosa should be managed in specialist services that have experience and expertise in its management. Comprehensive general CAMHS might, however, be well placed to manage milder cases. Further research should focus on the specific components of outpatient psychological therapies. Although family-based treatments are well established, trials have not established their effectiveness compared with good-quality individual psychological therapies and the combination of individual and family approaches is untested. Further research is needed to establish which patients (if any) might respond to inpatient psychiatric treatment when unresponsive to outpatient care, the positive and negative components of it and the optimum length of stay.NRR number (National Research Register) N0484056615; Current Controlled Trials ISRCTN39345394.
Health Technology Assessment, 14(15) : 1-98
- 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: Service Delivery & Improvement, Other service delivery and improvement interventions
Fisher, Caroline A., Hetrick, Sarah E., Rushford, Nola
Background: Objectives: Search Strategy: Selection Criteria: Data Collection and Analysis: Main Results: Authors' Conclusions: Anorexia Nervosa (AN) is characterised by distorted body image and deliberately maintained low body weight. The long term prognosis is often poor, with severe medical, developmental and psychosocial complications, high rates of relapse and mortality. Different variants of family therapy have been commonly used for intervention.To evaluate the efficacy of family therapy compared with standard treatment and other treatments.The Cochrane Collaboration Depression, Anxiety and Neuroses Controlled Trials Register (CCDANCTR) was searched until August 2008; MEDLINE, PsycInfo and EMBASE and ClinicalTrials.gov were searched up to January 2008. A conference abstract book and included studies reference lists were searched. All lead authors of included studies were also contacted.Randomised controlled trials (RCTS) of interventions described as 'family therapy' compared to any other intervention or other types of family therapy were eligible for inclusion. Patients of any age or gender with a primary clinical diagnosis of anorexia nervosa (AN) were included.Two review authors selected the studies, assessed quality and extracted data. We used a random effects meta-analysis. Relative risk was used to summarise dichotomous outcomes and both the standardised mean difference and mean difference to summarise continuous measures.13 trials were included, the majority investigating family based therapy, or variants. Reporting of trial conduct was generally inadequate. The full extent of the risk of bias is unclear. There was some evidence (from two studies, 81 participants) to suggest that family therapy may be more effective than treatment as usual on rates of remission, in the short term (RR 3.83 95% CI 1.60 to 9.13). Based on one study (30 participants) there was no significant advantage for family therapy over educational interventions (RR 9.00 95% CI 0.53, 153.79) or over other psychological interventions (RR 1.13 95% CI 0.72 to 1.76) based on four studies (N=149).All other reported comparisons for relapse rates, cognitive distortion, weight measures and dropouts yielded non-significant results.There is some evidence to suggest that family therapy may be effective compared to treatment as usual in the short term. However, this is based on few trials that included only a small number of participants, all of which had issues regarding potential bias. There appears to be little advantage of family therapy over other psychological interventions. The field would benefit from a large, well-conducted trial.
Cochrane Database of Systematic Reviews, (4) : CD004780
- Year: 2010
- 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
Fogarty, S., Harris, D., Zaslawski, C., McAinch, A. J., Stojanovska, L.
Objective: This study examines the role of acupuncture as an adjunct therapy in the treatment of eating disorders in female patients. Design: A randomised cross-over study was used in this study. The two treatments phases were the private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia, only (referred to as their treatment as usual) and a continuation of their treatment as usual supplemented by acupuncture. Participants: Patients receiving treatment at a private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia were asked to participate in the study. Nine consenting women (5 with Anorexia Nervosa, 4 with Bulimia Nervosa), aged (mean and SD) 23.7 (9.6) years, participated in the study. Main outcome measures: The main outcome measure was the Eating Disorder Inventory-3. Secondary outcome measures were the Becks Depression Inventory-2, State Trait Anxiety Inventory and the Eating Disorder Quality of Life Scale. Results: There was evidence that acupuncture improved the participants' Quality of Life as measured by the physical/cognitive and psychological components of the Eating Disorder Quality of Life scale. There was also evidence of decreases in anxiety (both State and Trait as measured by the State Trait Anxiety Intervention) and perfectionism (as measured by the Eating Disorder Inventory-3). Conclusion: This pilot study shows potential of the benefit of acupuncture as an adjunct therapy in the treatment of eating disorders particularly in the area of quality of life. (copyright) 2010.
Complementary Therapies in Medicine, 18(6) : 233-240
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Acupuncture, acupressure
Carei, T. Rain, Fyfe-Johnson, Amber L., Breuner, Cora C., Brown, Margaret A.
Purpose: Methods: Results: Conclusions: This was a pilot project designed to assess the effect of individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified).A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care (attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food Preoccupation questionnaire.The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and decreased in anxiety and depression over time.Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy holds promise as adjunctive therapy to standard care.; Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.
Journal of Adolescent Health, 46(4) : 346-351
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Carter, Jacqueline C., McFarlane, Traci L., Bewell, Carmen, Olmsted, Marion P., Woodside, D. Blake, Kaplan, Allan S., Crosby, Ross D.
Objective: Method: Results: Discussion: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU).This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse.When relapse was defined as a BMI
International Journal of Eating Disorders, 42(3) : 202-207
- Year: 2009
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
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Stage: Relapse prevention
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Wade, Tracey D., Frayne, Anna, Edwards, Sally-Anne, Robertson, Therese, Gilchrist, Peter
Objective: Method: Results: Conclusions: The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales.Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up.Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.
Australian & New Zealand Journal of Psychiatry, 43(3) : 235-243
- Year: 2009
- 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)
, Motivational interviewing, includes Motivational Enhancing Therapy
Korrelboom, Kees, de Jong, Martie, Huijbrechts, Irma, Daansen, Peter
This study evaluates a short stepwise cognitive-behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2 indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed.; (c) 2009 APA, all rights reserved.
Journal of Consulting & Clinical Psychology, 77(5) : 974-980
- Year: 2009
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Bissada, H., Tasca, G. A., Barber, A. M., Bradwejn, J.
Objective: Anorexia nervosa is associated with high mortality, morbidity, and treatment costs. Olanzapine, an atypical antipsychotic, is known to result in weight gain in other patient populations. The objective of this trial was to assess the efficacy of olanzapine in promoting weight gain and in reducing obsessive symptoms among adult women with anorexia nervosa. Method: The study was a double-blind, placebo-controlled, 10-week flexible dose trial in which patients with anorexia nervosa (N=34) were randomly assigned to either olanzapine plus day hospital treatment or placebo plus day hospital treatment. Results: Compared with placebo, olanzapine resulted in a greater rate of increase in weight, earlier achievement of target body mass index, and a greater rate of decrease in obsessive symptoms. No differences in adverse effects were observed between the two treatment conditions. Conclusions: These preliminary results suggest that olanzapine may be safely used in achieving more rapid weight gain and improvement in obsessive symptoms among women with anorexia nervosa. Replication, in the form of a large multicenter trial, is recommended.
American Journal of Psychiatry, 165(10) : 1281-1288
- Year: 2008
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Bloomgarden, A., Calogero, R. M.
Eye Movement Desensitization and Reprocessing (EMDR) therapy is being used by some clinicians to treat eating disorders. Although there is anecdotal and case study data supporting its use, there are no controlled studies examining its effectiveness with this population. This study examined the short and long-term effects of EMDR in a residential eating disorders population. A randomized, experimental design compared 43 women receiving standard residential eating disorders treatment (SRT) to 43 women receiving SRT and EMDR therapy (SRT+EMDR) on measures of negative body image and other clinical outcomes. SRT+EMDR reported less distress about negative body image memories and lower body dissatisfaction at posttreatment, 3-month, and 12-month follow-up, compared to SRT. Additional comparisons revealed no differences between the conditions pre to posttreatment on other measures of body image and clinical outcomes. The empirical evidence reported here suggests that EMDR may be used to treat specific aspects of negative body image in conjunction with SRT, but further research is necessary to determine whether or not EMDR is effective for treating the variety of eating pathology presented by eating disorder inpatients.
Eating Disorders., 16(5) : 418-427
- Year: 2008
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Eye movement desensitisation and reprocessing (EMDR)