Disorders - Eating Disorders
Loria-Kohen, V., Gomez-Candela, C., Palma-Milla, S., Amador-Sastre, B., Hernanz, A., Bermejo, L. M.
Background& Aims: Several authors have reported low folate intake in patients with eating disorders (ED). This vitamin plays an essential role in synthesis reactions for neurotransmitters and structural elements of neurons, and therefore its deficiency has been associated with the presence of different disorders linked to mental function. The aim of this study was to determine the effect of folic acid supplementation on homocysteine levels and the cognitive and depressive status of a group of patients with eating disorders with low folate intake.; Subjects/methods: The study was designed as a randomised, prospective clinical trial, which included 24 participants assigned to two treatment groups for six months: supplemented group (SG) (10 mg/day of folic acid [ACFOL]) and a placebo group (PG). Both groups maintained their medical, dietary and psychological treatment. At baseline and end of the intervention, anthropometric, dietary and biochemical parameters (plasma homocysteine [Hcy], serum and red blood cell folate) were recorded. Cognitive and depressive status questionnaires were administered (Stroop Test, Trail Making Test and Beck Depression Inventory).; Results: Twenty-two patients completed the study (SG: 12, PG: 10, mean age: 24.2 ± 8.8 years, BMI 18.9 ± 3.5 kg/m2). The SG significantly increased their serum and red blood cell folate levels and lowered Hcy levels (9.4 ± 2.4 μmol/l vs. 7.5 ± 1.7 μmol/l, P < 0.01). The SG also significantly improved most of their test scores for cognitive and depressive status. The PG showed no significant changes in any of the evaluated variables.; Conclusions: The results show that folic acid supplementation may be used as another tool within the comprehensive and multidisciplinary treatment applied to patients with ED.; Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.
Nutrición Hospitalaria, 28(3) : 807-815
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Marco, J. H., Perpina, C., Botella, C.
Body image disturbance is a significant maintenance and prognosis factor in eating disorders. Hence, existing eating disorder treatments can benefit from direct intervention in patients' body image. No controlled studies have yet compared eating disorder treatments with and without a treatment component centered on body image. This paper includes a controlled study comparing Cognitive Behavioral Treatment (CBT) for eating disorders with and without a component for body image treatment using Virtual Reality techniques. Thirty-four participants diagnosed with eating disorders were evaluated and treated. The clinical improvement was analyzed from statistical and clinical points of view. Results showed that the patients who received the component for body image treatment improved more than the group without this component. Furthermore, improvement was maintained in post-treatment and at one year follow-up. The results reveal the advantage of including a treatment component addressing body image disturbances in the protocol for general treatment of eating disorders. The implications and limitations of these results are discussed below. (copyright) 2013 Elsevier Ireland Ltd.
Psychiatry Research, 209(3) : 619-625
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Herpertz-Dahlmann, B.
Introduction: There are very few randomized, controlled studies exploring the effectiveness of treatment setting in adolescent Anorexia nervosa (AN). Method: In this multicenter trial, 176 female adolescents with a first admission for AN were randomized to either continued IP or DP treatment after a three-week inpatient stabilization period. The treatment program did not differ between the study arms. Results: DP was not inferior to IP with respect to weight gain at the 1-year follow-up (p<0.0001). Patients in the DP arm tended to have better psychosocial outcomes. The number of treatment-related serious adverse events did not differ between the study arms. Conclusions: DP treatment after short inpatient medical stabilization in adolescent patients with non-chronic AN was as effective as IP for weight restoration and thus may be a safe and less costly alternative to IP. Various prognostic factors as well as treatment acceptance will be analyzed and presented.
European Child & Adolescent Psychiatry, 22(2) : S96
- Year: 2013
- Problem: Eating Disorders (any), 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
Misra, M., Katzman, D. K., Estella, N. M., Eddy, K. T., Weigel, T., Goldstein, M. A., Miller, K. K., Klibanski, A.
Objective: Anorexia nervosa is characterized by low weight, aberrant eating attitudes, body image distortion, and hypogonadism. Anxiety is a common comorbid condition. Estrogen replacement reduces anxiety in animal models, and reported variations in food intake across the menstrual cycle may be related to gonadal steroid levels. The impact of estrogen replacement on anxiety, eating attitudes, and body image has not been reported in anorexia nervosa. We hypothesized that physiologic estrogen replacement would ameliorate anxiety and improve eating attitudes without affecting body image in anorexia nervosa. Method: Girls 13-18 years old with anorexia nervosa (DSM-IV) were randomized to transdermal estradiol (100 (mu)g twice weekly) with cyclic progesterone or placebo patches and pills for 18-months, between 2002 and 2010. The State-Trait Anxiety Inventory for Children (STAIC), the Eating Disorders Inventory-2 (EDI-2), and the Body Shape Questionnaire (BSQ-34) were administered. 72 girls completed these measures at baseline (n = 38 [girls receiving estrogen] and n = 34 [girls receiving placebo]) and 37 at 18 months (n = 20 [girls receiving estrogen] and n = 17 [girls receiving placebo]). The primary outcome measure was the change in these scores over 18 months. Results: Estrogen replacement caused a decrease in STAIC-trait scores (-3.05 [1.22] vs 2.07 [1.73], P = .02), without impacting STAIC-state scores (-1.11 [2.17] vs 0.20 [1.42], P = .64). There was no effect of estrogen replacement on EDI-2 or BSQ-34 scores. Body mass index (BMI) changes did not differ between groups, and effects of estrogen replacement on STAIC-trait scores persisted after controlling for BMI changes (P = .03). Increases in serum estradiol were significantly associated with decreases in STAIC-trait scores (Spearman (rho) = -0.45, P = .03). Conclusions: Estrogen replacement improved trait anxiety (the tendency to experience anxiety) but did not impact eating attitudes or body shape perception. (copyright) Copyright 2013 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 74(8) : e765-e771
- Year: 2013
- Problem: Anxiety Disorders (any), Eating Disorders (any), 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
Ng, L. W. C., Ng, D. P., Wong, W. P.
Background: Anorexia nervosa is an eating disorder that is often preceded by excessive physical activity. As such, exercise is not often prescribed in the clinical management of individuals with anorexia nervosa. Objective: To examine the effects of supervised exercise training in patients with anorexia nervosa. Data sources: Five databases were searched from their inception to Week 14 of 2011 using the subject headings 'anorexia' and 'exercise' to identify relevant studies. Eligibility criteria: PRISMA guidelines were followed. Studies that investigated the effects of inclusion of supervised exercise training in clinical management with usual management in patients diagnosed with anorexia nervosa were included in this review. Case reports were excluded. Data extraction and synthesis: Two reviewers independently extracted data using a standardised assessment form. Quality assessment was rated for the controlled trials and single-group studies using the PEDro scale and Downs and Black scale, respectively. Fixed or random effect approaches were used to determine effect size, depending on the heterogeneity of the studies. Results: Pooled randomised controlled trials and quasi-randomised studies showed no significant effect of supervised exercise training on selected anthropometric measurements, while the single-group studies showed significant improvement in weight and body fat. Although Short Form-36 revealed no training effect, distorted feelings about food and exercise were reduced. Cardiovascular fitness also improved with no decrease in weight. Limitations: Heterogeneity of exercise training programmes, small sample size (. n(less-than or equal to). 20) for 67% of the trials, and inability to exclude publication bias. Conclusions: Inclusion of supervised exercise training in the comprehensive management of patients with anorexia nervosa appears to be safe, as no detrimental effect was observed in anthropometry. Strength and cardiovascular fitness were also shown to improve. (copyright) 2012 Chartered Society of Physiotherapy.
Physiotherapy, 99(1) : 1-11
- Year: 2013
- Problem: Eating Disorders (any), Anorexia Nervosa
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Physical activity, exercise
Palmer, R., Nascimento, L. N., Fonagy, P.
This article reviews outcomes of psychodynamic psychotherapy (PP) for children and adolescents reported in articles identified by a comprehensive review of the literature on treatment evaluations of psychological and medical interventions for mental disorders in pediatric populations. The review identified 48 reports based on 33 studies. While there is evidence of substantial clinical gains associated with PP, in almost all the studies, when contrasted with family-based interventions, PP fares no better and appears to produce outcomes with some delay relative to family-based therapies. Further rigorous evaluations are needed, but evidence to date suggests that the context in which PP is delivered should be extended from the traditional context of individual therapy and parents should be included in the treatment of children. (copyright) 2013 Elsevier Inc.
Child & Adolescent Psychiatric Clinics of North America, 22(2) : 149-214
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any), Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis
Stein, K. F., Corte, C., Chen, D-G. D., Nuliyalu, U., Wing, J.
Objective: Findings of a randomized trial of an identity intervention programme (IIP) designed to build new positive self-schemas that are separate from other conceptions of the self in memory as the means to promote improved health in women diagnosed with eating disorders are reported.; Method: After baseline data collection, women with anorexia nervosa or bulimia nervosa were randomly assigned to IIP (n = 34) or supportive psychotherapy (SPI) (n = 35) and followed at 1, 6, and 12 months post-intervention.; Results: The IIP and supportive psychotherapy were equally effective in reducing eating disorder symptoms at 1 month post-intervention, and changes were stable through the 12-month follow-up period. The IIP tended to be more effective in fostering development of positive self-schemas, and the increase was stable over time. Regardless of baseline level, an increase in the number of positive self-schemas between pre-intervention and 1-month post-intervention predicted a decrease in desire for thinness and an increase in psychological well-being and functional health over the same period.; Discussion: A cognitive behavioural intervention that focuses on increasing the number of positive self-schemas may be central to improving emotional health in women with anorexia nervosa and bulimia nervosa.; Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 21(2) : 130-142
- Year: 2013
- Problem: Eating Disorders (any), Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Supportive therapy, Other Psychological Interventions
Sharpe, H., Schobe, I., Treasure, J., Schmidt, U.
Background: Body image dissatisfaction during adolescence is common but not benign. School-based interventions have the potential for wide reach, but scalability of previous programmes is limited by a reliance on external facilitators. Aims: To assess the acceptability, feasibility and efficacy of a teacher-delivered body image intervention. Method: A pilot clustered randomised controlled trial in which 16 classes of adolescent girls were allocated to a 6-session body image programme (n = 261), or usual curriculum control (n = 187) (registration: ISRCTN42594993). Results: Students in the intervention group had significantly improved body esteem and self-esteem and reduced thin-ideal internalisation. Effects for body esteem and thin-ideal internalisation were maintained for 3 months. There were no group differences for eating pathology, peer factors or depression. Acceptability, feasibility and efficacy varied between schools. Conclusions: Teacher-delivered body image lessons have promise but further work is needed to increase efficacy and make interventions suitable across a range of schools. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
British Journal of Psychiatry, 203(6) : 428-435
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A., Hyer, K., Granley, M., Berrett, M.
Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimokawa, Lambert, & Smart, 2010). Although these interventions work well in outpatient settings their effects so far have not been investigated with eating-disordered patients or in inpatient care. In this study, the effect of providing feedback interventions was investigated in a randomized clinical trial involving 133 females diagnosed with anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Comparisons were made between the outcomes of patients randomly assigned to either treatment-as-usual (TAU) or an experimental condition (Fb) within therapists (the same therapists provided both treatments). Patients in the Fb condition more frequently experienced clinically significant change than those who had TAU (52.95% vs. 28.6%). Similar trends were noted within diagnostic groups. In terms of pre to post change in mental health functioning, large effect sizes favored Fb over TAU. Patients' BMI improved substantially in both TAU and the feedback condition. The effects of feedback were consistent with past research on these approaches although the effect size was smaller in this study. Suggestions for further research are delineated.
Psychotherapy Research, 23(3) : 287-300
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Ruiz-Lazaro, P. M., Zapata, M. A., Calvo, A. I.
Introduction: The ZARIMA Prevention Group multi-disciplinary team which works on ED has developed a community action programme to promote mental health through primary and secondary prevention (published in Directory of Projects in Europe, Mental Health Promotion of Adolescents and Young People M.H.E. financed by the European Commission). Method: The intervention consisted of 5 weekly sessions of 120 min duration. It was integrated into the regular school hours, with small group activities, involvement techniques in eating nutrition, body image, gender differences, sociocultural influences, self-esteem/self concept and social skills. Work was effected with adolescents, parents and teachers with ZARIMA programme This combined teacher assessment, parent training, and skills training. Different technical and methodological approaches were applied, included role-playing, discussion within small groups, videotape, slides, drawing, performance. The interventions were designed to reach the students on cognitive, emotional and behavioural levels. The interventions were conducted in a coeducational setting without a separate curriculum for male or female students. Standardised psychological measure (EAT- 26, SCAN with DSM-IV, ICD-10 diagnosis) is used with the intervention and control group, pre- and post-intervention. One year later a booster session on nutrition and body image, was given with a DVD video and a pamphlet, for pupils, and another for parents. Guide has been published for the prevention of ED and is distributed free of charge. Results: The ZARIMA programme has proved to be effective when evaluated scientifically (result in a decrease statistically significant in the incidence of eating disorders in intervention group) at the 1 year follow-up using standardized methods. After 12-month follow-up the risk of ED in the intervention group was almost one-third that in the control group (4.1 vs. 10.5 %), and the incidence of ED significant decrease in intervention group but not in control group (0.0 vs. 2.7 %). Conclusion: The number of subjects of this pilot study was small. It would therefore be inappropriate to generalize from its findings. Additional research was needed on using a testing this program with a more divergent and larger sample with randomised controlled trial with measurements pre- and post-intervention. A replication was required, a multicenter research project financed by F.I.S. PI 05/2533 (Spain Health Department). Our previous study provides preliminary evidence that the primary prevention of ED in adolescents in school is possible. Our findings in replication study suggest that school interventions for adolescents is useful in prevention of ED.
European Child & Adolescent Psychiatry, 22(2) : S310-S311
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Yager, Z., Diedrichs, P. C., Ricciardelli, L. A., Halliwell, E.
Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d = 0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area. (copyright) 2013 Elsevier Ltd.
Body Image, 10(3) : 271-281
- Year: 2013
- Problem: Eating Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Wagner, G., Penelo, E., Nobis, G., Mayerhofer, A., Schau, J., Spitzer, M., Imgart, H., Karwautz, A.
Summary: Objective: This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). Method: One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology. Results: In all, 44 % of adolescents vs. 38.7 % of adults were in remission at month 7, and 55 % of adolescents vs. 62.5 % of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in almost all EDI-2 subscales. Conclusions: E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents as for adults with BN, and can be recommended as an initial step of treatment for this younger age group. (copyright) 2013 Springer-Verlag Wien.
Neuropsychiatrie, 27(2) : 66-73
- Year: 2013
- Problem: Eating Disorders (any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Self-help
, Technology, comparing delivery mode (e.g. online vs. face-to-face)