Disorders - Anorexia Nervosa
Hay, P. J., Claudino, A. M., Touyz, S., Abd-Elbaky, G.
Background: Anorexia nervosa is a disorder with high morbidity and
significant mortality. It is most common in young adult women, in whom the incidence may be increasing. The focus of treatment has moved to an
outpatient setting, and a number of differing psychological therapies are presently used in treatment. This is an update of a Cochrane review which
was last published in 2008.; Objectives: To assess the effects of specific individual psychological therapies for anorexia nervosa in adults or older
adolescents treated in an outpatient setting.; Search Methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised
Register (CCDANCTR) (16 July 2014). This register includes relevant randomised controlled trials from: the Cochrane Library (all years), MEDLINE
(1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We screened reference lists of all included studies and sent letters to
identified, notable researchers requesting information on unpublished or ongoing studies.; Selection Criteria: All randomised controlled trials of
one or more individual outpatient psychological therapies for adults with anorexia nervosa, as defined by DSM-5 or similar international criteria.;
Data Collection and Analysis: We selected a range of outcome variables, including physical state, severity of eating disorder attitudes and beliefs,
interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons used the mean or standardised mean difference
(MD or SMD), and binary outcome comparisons used the risk ratio (RR). Two review authors (PH and AC or ST) extracted data independently.; Main
Results: We identified 10 trials from the search, with a total of 599 anorexia nervosa participants, and included them in the review. Seven had been
identified in the previous versions of this review and we now include three new trials. We now deem one previously identified ongoing trial to be
ineligible, and six ongoing trials are new for this update. Two of the 10 trials included children. Trials tested diverse psychological therapies and
comparability was poor. Risks of bias were mostly evident through lack of blinded outcome assessments (in 60% of studies) and incomplete data
reporting (attrition bias).The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be
less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate
outcome on the Morgan and Russell Scale (RR 0.70, 95% confidence interval (CI) 0.51 to 0.97; 1 RCT, 40 participants; very low-quality evidence).
However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, 71 participants;
very low-quality evidence), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological
therapies and TAU.Two trials found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by
therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91; 197
participants, low-quality evidence). When comparing individual psychological therapies with each other, no specific treatment was consistently
superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (35 participants). None of the
trials identified any adverse effects. Insufficient power was problematic for the majority of trials.; Authors' Conclusions: There was a suggestion
in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control
condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations
of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for
anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.;
Cochrane Database of Systematic Reviews, (7) : CD003909
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Herpertz-Dahlmann, B., Krei, M., Buhren, K., Schwarte, R., Egberts, K., Wewetzer, C., Pfeiffer, E., Fleischhaker,
C., Konrad, K., Schade-Brittinger, C., Timmesfeld, N., Dempfle, A.
Day patient treatment (DP) is superior to inpatient treatment (IP) in adolescent anorexia
nervosa (AN): results of the 2.5 year follow-up of a multicenter RCT trial in 172 patients Introduction: Guidelines of several European countries and
the US consider IP as the treatment of choice for moderately to severely ill adolescent patients with AN, but it is costly and relapse rates are
high. DPis less expensive and may avoid relapse by easing the transition from hospital to home. Methods: Multicenter, randomized, open-label trial
with 11-18 year old participants from six centers in Germany with first admission to hospital for AN. After 3 weeks of inpatient care patients were
randomly assigned to either IP or DP with an identical treatment program in both settings.The primary outcome was the increase in BMI between
admission and 12-month follow-up and between admission and 2.5 years follow-up. Results: 172 adolescent patients were randomized to either treatment
arm; 161 (94 %) were followed up after 12 months, 143 (83 %) after 2.5 years. At the 12-month follow-up DP was not inferior to IP. At the 2.5 year
follow-up DP was significantly superior to IP with regard to BMI and was followed by significantly less rehospitalisations. In addition DP was less
costly than IP and psychosexual development, an important outcome predictor, was better in DP patients. Conclusions: After 1 year DP was not less
effective than IP; after 2.5 years it was superior to DP for weight restoration and maintenance and number of rehospitalisations. Thus, in the longer
term DP is a safe, less costly and probably more effective alternative to IP. Characteristics of patients, who are doing better in either DP or IP,
are described.
European Child & Adolescent
Psychiatry, 24(1) : S97
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
McElroy, S. L., Guerdjikova, A. I., Mori, N., Keck-Jr, P. E.
Psychopharmacologic treatment is playing a greater role in the management of patients with eating disorders. In this paper, we review randomized,
placebo-controlled trials (RCTs) conducted in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders
over the past 3 years. Fluoxetine remains the only medication approved for an eating disorder, that being BN. RCTs of antipsychotics in AN have had
mixed results; the only agent with some evidence of efficacy is olanzapine. One study suggests dronabinol may induce weight gain in AN. Preliminary
studies suggest lack of efficacy of alprazolam, dehydroepiandrosterone, or physiologic estrogen replacement in AN; erythromycin in BN; and the opioid
antagonist ALKS-33 in BED. In BED with obesity or overweight, bupropion may cause mild weight loss without seizures, and chromium may improve glucose
regulation. Also in BED, three RCTs suggest the stimulant prodrug lisdexamfetamine may reduce binge eating episodes, and another RCT suggests
intranasal naloxone may decrease time spent binge eating. There remains a disconnection between the size of eating disorders as a public health
problem and the lack of pharmacotherapy research of these conditions.;
Current Psychiatry Reports, 17(5) : 35-35
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Other biological interventions
Mountford, V. A., Brown, A. Bamford, B., Saeidi, S., Morgan, J. F., Lacey, H.
Body image disturbance can be enduring and distressing to individuals with eating disorders and effective treatments remain limited. This
pilot study evaluated a group-based treatment-BodyWise-developed for use in full and partial hospitalization with patients with anorexia nervosa at
low weight. A partial crossover waitlist design was used. BodyWise (N = 50) versus treatment as usual (N = 40) were compared on standardized measures
of body image disturbance. Results demonstrated significant improvement in the group compared to treatment as usual for the primary outcome measure
(Eating Disorder Examination-Questionnaire Shape Concern subscale) and other manifestations of body image disturbance including body checking and
body image quality of life. BodyWise appeared acceptable to participants, and was easy to deliver within the pragmatics of a busy eating disorder
service. There is potential for its wider dissemination as a precursor to more active body image interventions. (PsycINFO Database Record (c) 2015
APA, all rights reserved) (journal abstract).
European Eating Disorders Review, 23(1) : 62-67
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Lock, J., Le-
Grange, D., Agras, W., Fitzpatrick, K. K., Jo, B., Accurso, E., Forsberg, S., Anderson, K., Arnow, K., Stainer, M.
Objective: Adolescents with Anorexia Nervosa (AN), treated
with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do.
Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the
feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to
re-feeding skills in poor early responders to FBT. Method: 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in
an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were
compared between groups. Outcomes: There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes
between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (> 95% of expected mean
BMI) by EOT at similar rates as those who had responded early. Conclusions: The results of this study suggest that it is feasible to use an adaptive
design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC
for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study
is needed to confirm these promising findings. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 73 : 90-95
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Kim, Y-
R., Eom, J-S., Yang, J-W., Kang, J., Treasure, J.
Background and Aim: Social difficulties and problems related to eating behaviour are common features of both
anorexia nervosa (AN) and bulimia nervosa (BN). The aim of this study was to examine the impact of intranasal oxytocin on consummatory behaviour and
emotional recognition in patients with AN and BN in comparison to healthy controls. Materials: A total of 102 women, including 35 patients with
anorexia nervosa (AN), 34 patients with bulimia nervosa (BN), and 33 healthy university students of comparable age and intelligence, participated in
a double-blind, single dose placebo-controlled cross-over study. A single dose of intranasal administration of oxytocin (40 IU) (or a placebo) was
followed by an emotional recognition task and an apple juice drink. Food intake was then recorded for 24 hours post-test. Results: Oxytocin produced
no significant change in appetite in the acute or 24 hours free living settings in healthy controls, whereas there was a decrease in calorie
consumption over 24 hours in patients with BN. Oxytocin produced a small increase in emotion recognition sensitivity in healthy controls and in
patients with BN, In patients with AN, oxytocin had no effect on emotion recognition sensitivity or on consummatory behaviour. Conclusions: The
impact of oxytocin on appetite and social cognition varied between people with AN and BN. A single dose of intranasal oxytocin decreased caloric
intake over 24 hours in people with BN. People with BN showed enhanced emotional sensitivity under oxytocin condition similar to healthy controls.
Those effects of oxytocin were not found in patients with AN. Trial Registration: ClinicalTrials.gov KCT0000716. (PsycINFO Database Record (c) 2016
APA, all rights reserved) (journal abstract).
PLoS ONE, 10(9) : ArtID
e0137514
- Year: 2015
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Levinson, C. A., Rodebaugh, T. L., Fewell, L., Kass, A. E., Riley, E. N., Stark, L. J., McCallum, K., Lenze, E. J.
Objective: Exposure therapy in anorexia nervosa has preliminarily been shown to be effective for increasing food intake. D-Cycloserine is
a glutamatergic N-methyl-d-aspartate receptor agonist that has been shown to facilitate the benefits of exposure therapy for anxiety disorders by
enhancing the emotional learning in the exposures; therefore, we examined D-cycloserine-facilitation of exposure therapy to increase body mass index
(BMI) in patients with anorexia nervosa.; Method: Participants (N = 36) with anorexia nervosa (diagnosed via DSM-IV) were recruited from a partial
hospitalization eating disorder clinic between February 2013 and November 2013. Participants were randomly assigned to receive exposure therapy plus
D-cycloserine (n = 20) or placebo (n = 16). Participants completed psychoeducation and 4 sessions of exposure therapy, with medication (D-cycloserine
vs placebo) given prior to the first 3 exposure sessions. They also completed a 1-month follow-up.; Results: As hypothesized, participants in the D-
cycloserine group showed a significantly greater increase in BMI than those in the placebo group (Wilk ? = 0.86, F3,32 = 2.20, P = .043, ?p(2) =
0.12). D-Cycloserine participants gained 3 pounds relative to 0.5 pounds in the placebo group. Both groups experienced significantly decreased
anxiety over the course of therapy (Wilk ? = 0.80, F3,32 = 3.32, P = .023, ?p(2) = 0.20).; Conclusions: This study preliminarily demonstrates that
D-cycloserine facilitates exposure therapy for anorexia nervosa, leading to increased weight gain. A potential mechanism is that participants who
receive D-cycloserine may generalize learning from within-session exposures to food intake during other similar meals, resulting in sustained
increases in BMI. Further research is needed to confirm these findings and test the putative mechanism that generalized learning from exposure
therapy can increase BMI and stabilize a healthy weight.; Trial Registration: ClinicalTrials.gov identifier: NCT01996644.; © Copyright 2015
Physicians Postgraduate Press, Inc.
Journal of Clinical
Psychiatry, 76(6) : e787-e793
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Psychoeducation, D-cycloserine (DCS)
Herpertz-Dahlmann, Beate., Schwarte, Reinhild., Krei, Melanie., Egberts, Karin., Warnke, Andreas., Wewetzer, Christoph., Pfeiffer, Ernst., Fleischhaker, Christian., Scherag, Andre., Holtkamp,
Kristian., Hagenah, Ulrich., Buhren, Katharina., Konrad, Kerstin., Schmidt, Ulrike., Schade-Brittinger, Carmen., Timmesfeld, Nina., Dempfle, Astrid.
Background: In-patient treatment (IP) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia
nervosa, but it is costly, and the risks of relapse and readmissions are high. Day patient treatment (DP) is less expensive and might avoid problems
of relapse and readmission by easing the transition from hospital to home. We investigated the safety and efficacy of DP after short inpatient care
compared with continued IP.; Methods: For this multicentre, randomised, open-label, non-inferiority trial, we enrolled female patients (aged 11-18
years) with anorexia nervosa from six centres in Germany. Patients were eligible if they had a body-mass index (BMI) below the tenth percentile and
it was their first admission to hospital for anorexia nervosa. We used a computer-generated randomisation sequence to randomly assign patients to
continued IP or DP after 3 weeks of inpatient care (1:1; stratified for age and BMI at admission). The treatment programme and treatment intensity in
both study groups were identical. The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age
and duration of illness (non-inferiority margin of 0·75 kg/m(2)). Analysis was done by modified intention to treat. This trial is registered with the
International Standard Randomised Controlled Trial Number Register, number ISRCTN67783402, and the Deutsches Register Klinischer Studien, number
DRKS00000101.; Findings: Between Feb 2, 2007, to April 27, 2010, we screened 660 patients for eligibility, 172 of whom we randomly allocated to
treatment: 85 to IP and 87 to DP. DP was non-inferior to IP with respect to the primary outcome, BMI at the 12-month follow-up (mean difference 0·46
kg/m(2) in favour of DP (95% CI, -0·11 to 1·02; pnon-inferiority<0·0001). The number of treatment-related serious adverse events was similar in both
study groups (eight in the IP group, seven in the DP group). Three serious adverse events in the IP group and two in the DP group were related to
suicidal ideation; one patient in the DP attempted suicide 3 months after she was discharged.; Interpretation: DP after short inpatient care in
adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year
after admission. Thus, DP might be a safe and less costly alternative to IP. Our results justify the broad implementation of this approach.; Funding:
German Ministry for Education and Research.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Lancet, 383(9924) : 1222-
1229
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Hay, Phillipa., Chinn, David., Forbes, David., Madden, Sloane., Newton,
Richard., Sugenor, Lois., Touyz, Stephen., Ward, Warren.
Objectives: This
clinical practice guideline for treatment of DSM-5 feeding and eating disorders was conducted as part of the Royal Australian and New Zealand College
of Psychiatrists (RANZCP) Clinical Practice Guidelines (CPG) Project 2013-2014.; Methods: The CPG was developed in accordance with best practice
according to the National Health and Medical Research Council of Australia. Literature of evidence for treatments of anorexia nervosa (AN), bulimia
nervosa (BN), binge eating disorder (BED), other specified and unspecified eating disorders and avoidant restrictive food intake disorder (ARFID) was
sourced from the previous RANZCP CPG reviews (dated to 2009) and updated with a systematic review (dated 2008-2013). A multidisciplinary working
group wrote the draft CPG, which then underwent expert, community and stakeholder consultation, during which process additional evidence was
identified.; Results: In AN the CPG recommends treatment as an outpatient or day patient in most instances (i.e. in the least restrictive
environment), with hospital admission for those at risk of medical and/or psychological compromise. A multi-axial and collaborative approach is
recommended, including consideration of nutritional, medical and psychological aspects, the use of family based therapies in younger people and
specialist therapist-led manualised based psychological therapies in all age groups and that include longer-term follow-up. A harm minimisation
approach is recommended in chronic AN. In BN and BED the CPG recommends an individual psychological therapy for which the best evidence is for
therapist-led cognitive behavioural therapy (CBT). There is also a role for CBT adapted for internet delivery, or CBT in a non-specialist guided
self-help form. Medications that may be helpful either as an adjunctive or alternative treatment option include an antidepressant, topiramate, or
orlistat (the last for people with comorbid obesity). No specific treatment is recommended for ARFID as there are no trials to guide practice.;
Conclusions: Specific evidence based psychological and pharmacological treatments are recommended for most eating disorders but more trials are
needed for specific therapies in AN, and research is urgently needed for all aspects of ARFID assessment and management.; Expert Reviewers: Associate
Professor Susan Byrne, Dr Angelica Claudino, Dr Anthea Fursland, Associate Professor Jennifer Gaudiani, Dr Susan Hart, Ms Gabriella Heruc, Associate
Professor Michael Kohn, Dr Rick Kausman, Dr Sarah Maguire, Ms Peta Marks, Professor Janet Treasure and Mr Andrew Wallis.; © The Royal Australian and
New Zealand College of Psychiatrists 2014.
Australian & New Zealand Journal of Psychiatry, 48(11) : 977-
1008
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Le-Grange, D., Lock, J., Accurso, E. C., Agras, W. S., Darcy, A., Forsberg, S., Bryson, S. W.
Objective: Long-term follow-up studies documenting
maintenance of treatment effects are few in adolescent anorexia nervosa (AN). This exploratory study reports relapse from full remission and
attainment of remission during a 4-year open follow-up period using a convenience sample of a subgroup of 65% (n = 79) from an original cohort of 121
participants who completed a randomized clinical trial comparing family-based therapy (FBT) and adolescent-focused individual therapy (AFT).; Method:
Follow-up assessments were completed up to 4 years posttreatment (average, 3.26 years). Available participants completed the Eating Disorder
Examination as well as self-report measures of self-esteem and depression at 2 to 4 years posttreatment.; Results: Two participants (6.1%) relapsed
(FBT: n = 1, 4.5%; AFT: n = 1, 9.1%), on average 1.98 years (SD = 0.14 years) after remission was achieved at 1-year follow-up. Ten new participants
(22.7%) achieved remission (FBT: n = 1, 5.9%; AFT: n = 9, 33.3%). Mean time to remission for this group was 2.01 years (SD = 0.82 years) from 1-year
follow-up. There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term
follow-up. Other psychopathology was stable over time.; Conclusion: There were few changes in the clinical presentation of participants who were
assessed at long-term follow-up. These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is
achieved. Clinical trial registration information-Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia
Nervosa; http://www.clinicaltrials.gov/; NCT00149786.; Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier
Inc. All rights reserved.
Journal of the American Academy of Child & Adolescent Psychiatry, 53(11) : 1162-
1167
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Smith, C., Fogarty, S., Touyz, S., Madden, S., Buckett, G., Hay, P.
Objectives: This study examined the
feasibility of conducting a randomized controlled trial of acupuncture compared with an active control in an inpatient setting, to examine
individuals' experience of the interventions, clinical outcomes from the trial, and to integrate data to explain the trial findings.; Design: This
was a pilot randomized controlled trial with in-depth interviews with trial participants.; Setting: The study was conducted at a private medical
facility in Sydney, Australia.; Subjects: Twenty-six (26) patients with anorexia nervosa who were medically stable were the subjects.; Interventions:
Treatment as usual was administered, and the intervention was delivered twice a week for the first 3 weeks, followed by weekly treatment for three
weeks. The acupuncture group received acupuncture at the points Hegu (LI4), Zusanli (ST36), Neiguan (PC6), Taichong (LR3), Yanglingquan (GB34), and
additional points based on the Traditional Chinese Medicine diagnosis. The control group received acupressure and massage. Acupressure involved
consciously and gradually directing pressure to the center of the point being worked on.; Outcome Measures: Clinical outcomes were measured at
baseline and at 6 weeks following completion of the intervention. The primary outcome measure was body-mass index (BMI), and secondary outcomes
included eating disorder psychopathology, anxiety, and depression. A semistructured interview was conducted asking questions about their interaction
with the practitioner, what happened, how they felt, whether it made them feel differently, and what they attributed any change to.; Results: We
found timely recruitment with the population recruited within a 5-month period. Study dropouts were 23% and treatment compliance was moderate, but
acceptable for this challenging population. Participants in the control group demonstrated reduced eating concerns. Participants described both
interventions positively, and experienced a sense of calmness and relaxation.; Conclusions: Acupuncture and acupressure and massage may improve the
patient's subjective sense of wellbeing, and further research is needed.;
Journal of
Alternative & Complementary Medicine, 20(2) : 103-112
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Acupuncture, acupressure, Massage
Rocks, T., Pelly, F., Wilkinson, P.
Restoration of weight and nutritional rehabilitation are recognized
as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations
on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to
systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on
weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of
Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of
the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The
range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It
appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also
associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most
effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on
refeeding methods is crucial to establish the best practice approach to treatment of this population.; Copyright © 2014 Academy of Nutrition and
Dietetics. Published by Elsevier Inc. All rights reserved.
Journal of the Academy of Nutrition & Dietetics, 114(6) : 897-907
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions