Disorders - Anorexia Nervosa
Steinglass, J. E., Kaplan, S. C., Liu,
Y., Wang, Y., Walsh, B. T.
Objective: Anxiety is a prominent symptom in
anorexia nervosa (AN), and higher pre-meal anxiety has been associated with lower caloric intake. Yet, the causal relationship has not been assessed.
We proposed that reducing anxiety with a short acting benzodiazepine would increase caloric intake among individuals with AN.; Method: In a
randomized, double-blind, placebo controlled cross-over study, we administered alprazolam 0.75 mg to inpatients with AN (n?=?17) and assessed caloric
intake in a laboratory test meal. Within-subject differences in caloric intake, anxiety, and fatigue were compared between alprazolam and placebo
days.; Results: Caloric intake did not differ on alprazolam versus placebo (t(15)?=?1.72, p?=?.11). Alprazolam did not reduce anxiety, but was
associated with increased fatigue.; Discussion: This study was not able to evaluate the causal role of anxiety in meal intake among individuals with
AN, as alprazolam did not alter anxiety symptoms. These data further suggest that the therapeutic role for short-acting benzodiazepines in AN is
likely limited.; © 2014 Wiley Periodicals, Inc.
International Journal
of Eating Disorders, 47(8) : 901-904
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Anxiolytics including benzodiazepines
Brambilla, Francesca., Amianto, Federico., Dall-Grave, Riccardo., Fassino, Secondo.
Background: Treatments of eating disorders result too often in partial psychological and physical remission,
chronicization, dropout, relapse and death, with no fully known explanations for this failure. In order to clarify this problem, we conducted three
studies to identify the biochemical background of cognitive-behavioural psychotherapy (CBT), individual psychology brief psychotherapy (IBPP), and
psychotherapy-pharmacotherapy with CBT + olanzapine in anorexics (AN) and bulimics (BN) by measuring the levels of plasma homovanillic acid (HVA) for
dopamine secretion, plasma 3-methoxy-4-hydroxy-phenylglycol (MHPG) for noradrenalin secretion, and platelet [3H]-Paroxetin-binding Bmax and Kd for
serotonin transporter function. The data were then compared with psychopathological and physical alterations.; Methods: Study 1 investigated the
effects of 4 months of CBT on plasma HVA, MHPG and [3H]-Par-binding in 14 AN-restricted, 14 AN-bingeing/purging, and 22 BN inpatients. Study 2
investigated the effects of 4 months of IBPP on plasma HVA in 15 AN and 17 BN outpatients. Study 3 investigated the effect of 3 months of CBT +
olanzapine (5 mg/day) in 30 AN outpatients. The data were analyzed using one-way ANOVA for repeated measures for the changes between basal and post-
treatment biological and psychological parameters, two-way ANOVA for repeated measures for the differences in the psychobiological data in the 3
groups, Spearman's test for the correlations between basal and final changes in the psychological and biological scores.; Results: Study 1 revealed
significant amelioration of the psychopathology in the AN and BN patients, no effects on HVA, MHPG or Paroxetin binding Kd, and a significant
increase in Par-binding Bmax only in the BN patients. Study 2 revealed a significant effect of IBPP on psychopathology in the AN and BN patients, and
a significant increase in HVA only in the BN patients. Study 3 revealed a significant positive effect of CBT + olanzapine therapy on the
psychopathology and increased HVA values. No correlations were observed in the 3 groups between biological and psychological effects of the three
treatments.; Conclusions: Our data advance suggestions on the mechanism of action of the three therapies; however, the lack of correlations between
biochemical and psychological effects casts doubt on their significance. Clinical Trials.gov. Identifier NCT01990755 .;
BMC Psychiatry, 14 : 376-
376
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Brockmeyer, Timo., Ingenerf, Katrin., Walther, Stephan., Wild, Beate., Hartmann,
Mechthild., Herzog, Wolfgang., Bents, Hinrich., Friederich, Hans-Christoph.
Objective: Inefficient cognitive flexibility is considered a neurocognitive trait marker involved in
the development and maintenance of anorexia nervosa (AN). Cognitive Remediation Therapy (CRT) is a specific treatment targeting this cognitive style.
The aim of this study was to investigate the feasibility and efficacy (by estimating the effect size) of specifically tailored CRT for AN, compared
to non-specific cognitive training.; Method: A prospective, randomized controlled, superiority pilot trial was conducted. Forty women with AN
receiving treatment as usual (TAU) were randomized to receive either CRT or non-specific neurocognitive therapy (NNT) as an add-on. Both conditions
comprised 30 sessions of computer-assisted (21 sessions) and face-to-face (9 sessions) training over a 3-week period. CRT focused specifically on
cognitive flexibility. NNT was comprised of tasks designed to improve attention and memory. The primary outcome was performance on a
neuropsychological post-treatment assessment of cognitive set-shifting.; Results: Data available from 25 treatment completers were analyzed.
Participants in the CRT condition outperformed participants in the NNT condition in cognitive set-shifting at the end of the treatment (p = 0.027;
between-groups effect size d = 0.62). Participants in both conditions showed high treatment acceptance.; Discussion: This study confirms the
feasibility of CRT for AN, and provides a first estimate of the effect size that can be achieved using CRT for AN. Furthermore, the present findings
corroborate that neurocognitive training for AN should be tailored to the specific cognitive inefficiencies of this patient group.; Copyright © 2013
Wiley Periodicals, Inc.
International Journal of Eating Disorders, 47(1) : 24-
31
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive remediation
therapy, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Agras, W. Stewart, Lock, James, Brandt, Harry, Bryson, Susan W., Dodge, Elizabeth, Halmi, Katherine A., Jo,
Booil, Johnson, Craig, Kaye, Walter, Wilfley, Denise, Woodside, Blake
Importance: Anorexia nervosa (AN) is a serious disorder with high rates
of morbidity and mortality. Family-based treatment (FBT) is an evidence-based therapy for adolescent AN, but less than half of those who receive this
approach recover. Hence, it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no
known evidence-based treatment.; Objective: To compare FBT with systemic family therapy (SyFT) for the treatment of adolescent-onset AN.; Design,
Setting, and Participants: Research in Anorexia Nervosa (RIAN) is a 2-group (FBT and SyFT) randomized trial conducted between September 2005 and
April 2012. Interviewers were blinded to the treatment condition. A total of 564 adolescents receiving care at 6 outpatient clinics experienced in
the treatment of AN were screened. Of these, 262 adolescents did not meet the inclusion criteria and 138 declined to participate; hence, 164
adolescents (aged 12-18 years) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AN
(except for amenorrhea) were enrolled. Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events
occurred.; Interventions: Two manualized family therapies with 16 one-hour sessions during 9 months. Family-based therapy focuses on the facilitation
of weight gain, whereas SyFT addresses general family processes.; Main Outcomes and Measures: The primary outcomes were percentage of ideal body
weight (IBW) and remission (=95% of IBW). The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end
of treatment (EOT).; Results: There were no statistically significant differences between treatment groups for the primary outcome, for eating
disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up. Remission rates included FBT, 33.1% at the EOT and 40.7% at follow-up
and SyFT, 25.3% and 39.0%, respectively. Family-based therapy led to significantly faster weight gain early in treatment, significantly fewer days in
the hospital, and lower treatment costs per patient in remission at the EOT (FBT, $8963; SyFT, $18?005). An exploratory moderator analysis found that
SyFT led to greater weight gain than did FBT for participants with more severe obsessive-compulsive symptoms.; Conclusions and Relevance: The
findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to
similar outcomes at a lower cost than SyFT. Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT.; Trial
Registration: clinicaltrials.gov Identifier NCT00610753.;
JAMA
Psychiatry, 71(11) : 1279-1286
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Dalle-Grave, R., Calugi, S., Conti, M., Doll, H., Fairburn, C. G.
Background: The aim of this study was to compare the immediate and
longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa, one focused exclusively on the
patients' eating disorder features and the other focused also on mood intolerance, clinical perfectionism, core low self-esteem or interpersonal
difficulties. Both programmes were derived from enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Methods: Eighty consecutive
patients with severe anorexia nervosa were randomized to the two inpatient CBT-E programmes, both of which involved 20 weeks of treatment (13 weeks
as an inpatient and 7 as a day patient). The patients were then followed up over 12 months. The assessments were made blind to treatment condition.
Results: Eighty-one percent of the eligible patients accepted inpatient CBT-E, of whom 90% completed the 20 weeks of treatment. The patients in both
programmes showed significant improvements in weight, eating disorder and general psychopathology. Deterioration after discharge did occur but it was
not marked and it was restricted to the first 6 months. There were no statistically significant differences between the effects of the two
programmes. Conclusions: These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a
viable and promising treatment for severe anorexia nervosa. There appears to be no benefit from using the more complex form of the treatment.
Copyright (copyright) 2013 S. Karger AG, Basel.
Psychotherapy & Psychosomatics, 82(6) : 390-398
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Fichter, M. M., Quadflieg, N., Lindner, S.
Background: To study the longer term effects of an internet-based CBT
intervention for relapse prevention (RP) in anorexia nervosa.Methods: 210 women randomized to the RP intervention group (full and partial completers)
or the control group were assessed for eating and general psychopathology. Multiple regression analysis identified predictors of favorable course
concerning Body Mass Index (BMI). Logistic regression analysis identified predictors of adherence to the RP program.Results: Most variables assessed
showed more improvement for the RP than for the control group. However, only some scales reached statistical significance (bulimic behavior and
menstrual function, assessed by expert interviewers blind to treatment condition). Very good results (BMI) were seen for the subgroup of \" full
completers\" who participated in all nine monthly RP internet-based intervention sessions. \" Partial completers\" and controls (the latter non-
significantly) underwent more weeks of inpatient treatment during the study period than \" full completers\" , indicating better health and less need
for additional treatment among the \" full completers\" Main long-term predictors for favorable course were adherence to RP, more spontaneity, and
more ineffectiveness. Main predictors of good adherence to RP were remission from lifetime mood and lifetime anxiety disorder, a shorter duration of
eating disorder, and additional inpatient treatment during RP.Conclusions: Considering the high chronicity of AN, internet-based relapse prevention
following intensive treatment appears to be promising. (copyright) 2013 Fichter et al.; licensee BioMed Central Ltd.
Journal of Eating
Disorders, 1(1) :
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
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
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
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
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Lock, J., Agras, W. S., Fitzpatrick, K. K., Bryson, S. W., Jo, B., Tchanturia, K.
Objective There are limited data supporting specific treatments for adults with anorexia nervosa (AN). Randomized clinical trials (RCTs)
for adults with AN are characterized by high attrition limiting the feasibility of conducting and interpreting existing studies. High dropout rates
may be related to the inflexible and obsessional cognitive style of patients with AN. This study evaluated the feasibility of using cognitive
remediation therapy (CRT) to reduce attrition in RCTs for AN. Method Forty-six participants (mean age of 22.7 years and mean duration of AN of 6.4
years) were randomized to receive eight sessions of either CRT or cognitive behavioral therapy (CBT) over 2 months followed by 16 sessions of CBT for
4 months. Results During the 2-month CRT vs. CBT treatment, rates of attrition were lower in CRT (13%) compared with that of CBT (33%). There were
greater improvements in cognitive inefficiencies in the CRT compared with that of the CBT group at the end of 2 months. There were no differences in
other outcomes. Discussion These results suggest that CRT is acceptable and feasible for use in RCTs for outpatient treatment of AN. CRT may reduce
attrition in the short term. Adequately powered future studies are needed to examine CRT as an outpatient treatment for AN. (copyright) 2013 by Wiley
Periodicals, Inc. (Int J Eat Disord 2013; 46:567-575) Copyright (copyright) 2013 Wiley Periodicals, Inc., A Wiley Company.
International Journal of Eating Disorders, 46(6) : 567-
575
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy
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
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Lebow, J., Sim, L. A., Erwin, P.J., Murad, M. H.
Objective: Given that atypical antipsychotic medications have been increasingly prescribed for improving weight gain in anorexia nervosa
(AN), we conducted a systematic review and meta-analyses to estimate the influence of atypical antipsychotics on BMI, eating disorder, and
psychiatric symptoms in individuals with AN.; Method: Independent reviewers selected studies and extracted study characteristics, methodologic
quality, and outcomes for the intention-to-treat group from randomized clinical trials comparing the effect of atypical antipsychotic use to placebo
or an active control treatment on BMI.; Results: Compared with placebo, atypical antipsychotics were associated with a nonsignificant increase in BMI
(weighted mean difference, WMD = 0.18, 95% CI: -0.36, 0.72; I(2) = 26%) and a nonsignificant effect on the drive for thinness and body
dissatisfaction. Compared with placebo or active control, these medications led to an increase in anxiety and overall eating disorder symptoms.
However, there was a significant reduction over placebo or active control on level of depression.; Copyright © 2012 Wiley Periodicals, Inc.
International Journal of Eating
Disorders, 46(4) : 332-339
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
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