Disorders - Bulimia Nervosa
Milano, W., Petrella, C., Capasso, A.
Bulimia nervosa (BN) is one of the most frequent eating disorders in industrialized societies. Reduced serotonin activity has been suggested to trigger some of the cognitive and mood disturbances associated with BN. Therefore, pharmacological treatment of BN is mainly based on the use of selective serotonin reuptake inhibitors, that have proved effective. The biological basis of this disorder fully are not established yet. The aim of this randomized controlled trial was to verify the efficacy of citalopram, a selective serotonin reuptake inhibitor, in a group of BN diagnosed patients. Twenty female outpatients, with an age range of 19-28 years having BN-binge purging, as defined by the DSM IV, were assigned randomly into two treatment groups; the first group received 20-40 mg/day citalopram for 12 weeks and the second group had placebo. The study was conducted for 12 weeks with weekly clinical assessments. At the end of the observation period, the group treated with citalopram showed a statistically significant reduction in the number of binge-eating crisis and purging with respect to the group who received the placebo only. In no case, treatment was interrupted for any emergency reasons. This study indicates that citalopram is well tolerated and equally effective in reducing binge-eating crisis and purging in patients with BN.
Biomedical Research., 16(2) : 85-87
- Year: 2005
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Bailer, U., De Zwaan, M., Leisch, F., Strnad, A., Lennkh-Wolfsberg, C., El-Giamal, N., Hornik, K., Kasper, S.
Objective: The aim of the current study was to evaluate whether guided self-help was effective in the short and long term in the treatment of bulimia nervosa. Method: Eighty-one patients with bulimia nervosa were randomly assigned to either a self-help manual with a maximum of 18 short weekly visits (guided self-help) or to 18 weekly 1.5-h sessions of cognitive-behavioral group therapy (CBT). The primary outcome variables were monthly frequencies of self-reported binge eating and vomiting episodes. Secondary outcome variables were eating disorder-related psychopathology (assessed with the Eating Disorders Inventory [EDI]) and depression (assessed by the Beck Depression Inventory [BDI]). Patients were followed up 1 year after the end of treatment. Results: A mixed-effects linear regression analysis indicated that subjects in both treatment conditions showed a significant decrease over time in binge eating and vomiting frequencies, in the scores of the EDI subscales, and in the BDI. Both treatment modalities led to a sustained improvement at follow-up. A separate analysis of the completer sample showed significantly higher remission rates in the self-help condition (74%) compared with the CBT condition (44%) at follow-up. Conclusions: Guided self-help incorporating the use of a self-help manual offers an approach that can be effective in the short and long-term treatment of bulimia nervosa. copyright 2004 by Wiley Periodicals, Inc.
International Journal of Eating Disorders., 35(4) : 522-537
- Year: 2004
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Self-help
Erzegovesi, Stefano, Riboldi, Chiara, Di Bella, Daniela, Di Molfetta, Daniela, Mapelli, Francesca, Negri, Bruna, Tenace, Micaela, Bellodi, Laura
Letter to the editor evaluating the efficacy and safety of 4 selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, fluvoxamine, citalopram, and paroxetine) in comparison with placebo in 91 bulimic patients and to test the hypothesis that variation of 5-HTT gene expression is linked to clinical response to SSRIs. Inclusion criteria were age between 15 and 45 years and DSM-IV diagnosis of bulimia nervosa (BN). Duration of hospitalization was 42 days for all patients. Genotyping was performed blind to the outcome of the drug therapy. Patients were assigned to a standardized pharmacologic treatment according to an unbalanced randomized design, with one of these drugs: fluvoxamin, fluoxetine, paroxetine, citalopram, placebo. No concomitant therapy was allowed during the whole treatment period, except for low-dose benzodiazepines. Compared with placebo-treated patients, SSRIs-treated patients showed a significantly greater improvement in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score. The limit of our study is the lack of a double-blind design, but the standardization of treatment and the blind condition of raters and patients should have avoided misleading results. Our study demonstrates a significant efficacy of all SSRIs in the short-term treatment of BN. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Clinical Psychopharmacology, 24(6) : 680-682
- Year: 2004
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Durand, M. A., King, M.
Background: Little is known about general practice management of patients with eating disorders. Aim: To compare the effectiveness of a general practice-based, self-help approach to the treatment of bulimia nervosa with that of specialist outpatient treatment. Design of study: A prospective, parallel group, randomised controlled trial. Setting: General practices and specialist eating disorder clinics in London. Method: Patients were recruitedfrom general practitioner (GP) referrals to specialist eating disorder clinics. Thirty-four patients were randomised to receive the self-help intervention in general practice and thirty-Jour were randomised to the clinic intervention. Patients randomised to the self-help arm of the trial worked through a manual based on cognitive behaviour principles, while keeping in contact with their GPs. Those randomised to receive specialist treatment were managed in the specialist clinic to which they had been referred. The main outcome measure was the Bulimic Investigatory Test Edinburgh score, assessed at baseline and at six and nine months. Secondary measures were eating pathology, depression, and social adjustment. Results: A total of 74% and 80% of patients were allowed up at six and nine months respectively. An intention-to-treat analysis revealed that, while bulimic symptoms declined in both groups over time, there was no significant difference in outcome between the two groups. Conclusion: The findings lend support to the idea that patients with bulimia nervosa can be treated in general practice and that this approach warrants further investigation.
British Journal of General Practice., 53(490) : 371-377
- Year: 2003
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Self-help
, Other service delivery and improvement interventions
Chen, Eunice, Touyz, Stephen W., Beumont, Pierre J., Fairburn, Chistopher G., Griffiths, Rosalyn, Butow, Phyllis, Russell, Janice, Schotte, David E., Gertler, Robert, Basten, Christopher
The clinical effectiveness of group and individual cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) was compared. Sixty BN patients from hospitals and general practitioners in Sydney, Australia, were allocated randomly to group or individual CBT. Forty-four completed treatment (22 in group CBT and 22 in individual CBT). Patients were assessed at pretreatment, posttreatment, and at 3 and 6 months follow-up with the Eating Disorder Examination-12 and self-report questionnaires examining weight and shape attitudes (Eating Disorder Inventory-2), social adjustment (Social Adjustment Scale-Modified), self-esteem (Rosenberg Self-Esteem Scale), and general psychopathology (Symptom Checklist 90R). The effects of group and individual CBT were equivalent on most measures. However, a significantly greater proportion of individual CBT patients than group CBT patients were abstinent from bulimic behaviors at posttreatment, but not at follow-up. This has implications for the delivery of cost-effective and clinically effective treatment for BN. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
International Journal of Eating Disorders, 33(3) : 241-254
- Year: 2003
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
McComb, Jacalyn J., Clopton, James R.
The purpose of this study was to assess the impact of a multidisciplinary intervention program on the attitudes and symptoms associated with bulimia nervosa (BN). The Bulimia Test (BULIT) and subscales from the Eating Disorder Inventory-2 (EDI-2) associated with BN were administered to 373 females to determine eligibility for participation in the study. In order to qualify for the study, participants had to be female, not be anorexic, and meet one of four criteria indicating that they had some of the symptoms of BN. Following the screening, 12 females were randomly assigned to a control group (C, n=6) or an intervention group (I, n=6). The I group then participated in an 8-week multidisciplinary intervention program consisting of small group discussions, movement improvisation, and relaxation techniques. Dependent variables consisted of scores from standardized instruments for anxiety, self-esteem, and BN. Analysis indicated that compared to the C group, which showed no reduction in anxiety, the I group had a significant reduction in anxiety following the intervention program. No significant differences were found between groups for self-esteem or symptoms of BN. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Eating Behaviors, 4(1) : 79-88
- Year: 2003
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Psychoeducation, Physical activity, exercise, Relaxation
Sundgot-Borgen, Jorunn, Rosenvinge, Jan H., Bahr, Roald, Schneider, Laila Sundgot
Compared the effectiveness of physical exercise, cognitive-behavioral therapy (CBT), and nutritional advice as a component of CBT in the treatment of bulimia. Ss were 59 normal weight female bulimic 18-29 yr old patients randomly assigned to a physical exercise program, CBT, nutritional advice, or a waiting list control group. Treatment effects were determined by the frequency of binge eating and purging, scores on the Eating Disorder Inventory subscales Drive for Thinness, Bulimia, and Body Dissatisfaction, and by a clinical interview to measure symptom severity. Assessments were made before and after treatment and at 6- and 18-mo follow-up after the end of treatment. Results show that nutritional counseling was not more effective than CBT. Physical exercise appeared more effective than CBT in reducing pursuit of thinness, change in body composition, aerobic fitness, and frequency of binge eating, purging, and laxative abuse. It is concluded that physical exercise is important in the treatment of normal weight bulimic patients. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Medicine & Science in Sports & Exercise, 34(2) : 190-195
- Year: 2002
- Problem: Bulimia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Dietary advice, dietary change, Physical activity, exercise
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
-
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)
Gelber, Diana, Levine, Joseph, Belmaker, R.
Examined whether inositol has therapeutic value in patients with bulimia nervosa and binge eating. A double-blind crossover trial using 18 g inositol vs placebo was performed in 12 patients (aged 20-39 yrs) for 6 wks in each arm. The results show inositol was significantly better than placebo on the Global Clinical Impression, the Visual Analogue Scale, and the Eating Disorders Inventory. It is concluded that inositol is as therapeutic in patients with bulimia nervosa and binge eating as it is in patients with depression and panic and obsessive-compulsive disorders. This increases its parallelism with serotonin selective reuptake inhibitors. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
International Journal of Eating Disorders, 29(3) : 345-348
- Year: 2001
- Problem: Binge Eating Disorders, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Mitchell, JE., Fletcher, L., Hanson, K., Mussell, MP., Seim, H., Crosby, R., Al-Banna, M.
A randomized, placebo-controlled study was conducted examining the singular and combined effects of fluoxetine and a self-help manual on suppressing bulimic behaviors in women with bulimia nervosa. A total of 91 adult women (aged 18-46 yrs) with bullmia nervosa were randomly assigned to 1 of 4 conditions: placebo only, fluoxetine only, placebo and a self-help manual, or fluoxetine and a self-help manual. Ss were treated for 16 wks. Primary outcome measures included self-reports of bulimic behaviors. Fluoxetine and a self-help manual were found to be effective in reducing the frequency of vomiting episodes and in improving the response rates for vomiting and binge-eating episodes. Furthermore, both factors were shown to be acting additively on the primary and secondary efficacy measures in this study. Results are discussed in relation to previous research and the implications for treatment of bulimia nervosa. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Clinical Psychopharmacology, 21(3) : 298-304
- Year: 2001
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Self-help
Hsu, L., Rand, W., Sullivan, S., Liu, D., Mulliken, B., McDonagh, B., Kaye, W.
Compared the effectiveness of cognitive therapy (CT), nutritional therapy (NT), the combination of cognitive and nutritional therapy (CNT), against a control condition of support group (SG) in the treatment of bulimia nervosa. 100 female outpatients (mean age 24.5 yrs) with bulimia nervosa were randomized to the four treatment groups. NT and CT were designed to cover different areas with minimal overlap, and CNT provided all of the features of both of these treatments. The control condition was conducted in a group self-help format. Each of the treatments lasted 14 wks. All three active treatments as well as SG produced significant decreases in binge/vomit episodes. Intent-to-treat analysis found CNT and CT to be significantly more effective than SG in retaining Ss in treatment and completion of study, as well as in producing greater improvements in dysfunctional attitudes and self-control. CNT was superior to SG in achieving abstinence from bulimic behaviour. NT was superior to SG only in increase of self-control. Logistic regression found that the cognitive component, whether given alone or in conjunction with NT, and higher pre-treatment self-control scores were significant predictors for both completion of study and abstinence. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Psychological Medicine, 31(5) : 871-879
- Year: 2001
- Problem: Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Dietary advice, dietary change
Bachar, Eytan, Latzer, Yael, Kreitler, Shulamit, Berry, Elliot M.
The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. 33 female patients (mean age 24 yrs) participated in this study. The bulimic patients (N=25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (N=8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Psychotherapy Practice & Research, 8(2) : 115-128
- Year: 1999
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions