Disorders - Anorexia Nervosa
Kishi, Taro, Kafantaris, Vivian, Sunday, Suzanne, Sheridan, Eva M., Correll, Christoph U.
Objective: To assess the utility of
antipsychotics for weight gain and improvement of illness-related psychopathology in patients with anorexia nervosa.; Data Sources: PubMed, the
Cochrane Library databases, and PsycINFO citations from the inception of the databases until March 27, 2012, were searched without language
restrictions using the following keywords: randomized, random, randomly, and anorexia nervosa. In addition, we hand-searched for additional studies
eligible for inclusion in this meta-analysis and contacted authors for unpublished data.; Study Selection: Included in this study were randomized
placebo- or usual care-controlled trials of antipsychotics in patients with anorexia nervosa.; Data Extraction: Two independent evaluators extracted
data. The primary outcome of interest was body weight, expressed as the standardized mean difference (SMD) between the 2 groups in baseline to
endpoint change of body mass index (BMI), endpoint BMI, or daily weight change. SMD, risk ratio (RR), and number needed to harm (NNH) ± 95%
confidence interval (CI) were calculated.; Results: Across 8 studies (mean duration = 9.6 weeks; range, 7-12 weeks), 221 patients (mean age = 22.5
years, 219 [99.1%] females) with anorexia nervosa were randomly assigned to olanzapine (n = 54), quetiapine (n = 15), risperidone (n = 18), pimozide
(n = 8), sulpiride (n = 9), placebo (n = 99), or usual care (n = 18). Both individually (P = .11 to P = .47) and pooled together (SMD = 0.27, 95% CI,
-0.01 to 0.56; P = .06, I2 = 0%; 7 studies, n = 195), weight/BMI effects were not significantly different between antipsychotics and placebo/usual
care. Moreover, pooled antipsychotics and placebo/usual care did not differ regarding scores on questionnaires related to anorexia nervosa (P = .32,
5 studies, n = 114), body shape (P = .91, 4 studies, n = 100), depressive symptoms (P = .08, 4 studies, n = 103), and anxiety (P = .53, 4 studies, n
= 121). Individually, quetiapine (1 study, n = 33) outperformed usual care regarding eating disorder attitudes (P = .01) and anxiety (P = .02). While
rates of dropout due to any reason (P = .83, I2 = 0%) and due to adverse events (P = .54, I2 = 5%) were similar in both groups, drowsiness/sedation
occurred significantly more often with antipsychotics than placebo/usual care (RR = 3.69, 95% CI, 1.37-9.95; I2 = 67%, P = .01; NNH = 2, P = .001; 5
studies, n = 129), but most other adverse effects were only sparsely reported.; Conclusions: Although limited by small samples, this meta-analysis
failed to demonstrate antipsychotic efficacy for body weight and related outcomes in females with anorexia nervosa.; © Copyright 2012 Physicians
Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 73(6) : e757-e766
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Typical Antipsychotics (first generation), Atypical Antipsychotics (second
generation)
Hay, Phillipa J., Touyz, Stephen, Sud, Rishi
Objective: Many patients with anorexia nervosa develop an intractable and debilitating illness course. Our aims were to (i) conduct a
systematic review of randomised controlled trials (RCTs) of treatment for chronic anorexia nervosa participants, and (ii) identify research informing
novel therapeutic approaches for this group. Methods: Systematic search (SCOPUS plus previous reviews date 2011) of literature for (i) RCTs of
treatment that included anorexia nervosa participants with a mean duration of illness of at least 3 years, (ii) studies reporting new treatments
addressing factors associated with chronicity. Results: Evidence of efficacy for treatment approaches in severe and enduring anorexia nervosa is
limited. Only one unpublished RCT designed to test a specific psychological approach for these patients was identified. There is a probable advantage
for specialist psychotherapy over treatment as usual, and a promising study of relapse prevention with cognitive behaviour therapy (CBT) for anorexia
nervosa (CBT-AN). Open trials have, however, reported developments in psychological therapies that warrant further specific evaluation. These include
forms of CBT modified for anorexia nervosa, cognitive remediation therapy with emotion skills training, the Maudsley Model for Treatment of Adults
with Anorexia Nervosa, the Community Outreach Partnership Program, Specialist Supportive Clinical Management and the approach of Strober with its
emphasis on therapeutic alliance and flexible goals. Conclusions: Treatment trials need to move beyond targeting core eating disorder pathology
(primarily weight restoration) and examine efficacy and effectiveness in minimising harm and reducing personal and social costs of chronic illness.
There is also a need to develop better definitions of chronicity, with or without treatment 'resistance' specifiers.;
Australian & New Zealand Jounal of
Psychiatry, 46(12) : 1136-1144
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Kaslow, Nadine J., Broth, Michelle Robbins, Smith, Chaundrissa Oyeshiku, Collins, Marietta
H.
Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There
has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining
prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of
family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism
spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined
using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are
disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes
with a summary and directions for future research.; © 2012 American Association for Marriage and Family Therapy.
Journal of Marital & Family Therapy, 38(1) : 82-
100
- Year: 2012
- Problem: Anxiety Disorders (any), Depressive Disorders, Anorexia Nervosa, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
vanElburg, Annemarie A., Hillebrand, Jacquelien J. G., Huyser, Chaim, Snoek, Maartje, Kas, Martien J. H., Hoek, Hans
W., Adan, Roger A. H.
Objective: A comparison of the efficacy of a
novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU).; Method: During treatment data were
collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment Schedule (MROAS).; Results: After treatment
63% of the MT group and 85% of the TAU group had reached a normal weight level and both MT and TAU showed a good outcome on the MROAS (75 and 71%,
respectively). After two years more MT than TAU patients were still in treatment and more MT patients had relapsed.; Discussion: The outcome for both
treatments in our study were similar and comparable with, if not better than outcome data of other AN studies. MT is not superior to TAU in outcome
results and in relapse rate during the first two years following admission for AN treatment.; Copyright © 2011 Wiley Periodicals, Inc.
International Journal of Eating
Disorders, 45(2) : 193-201
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Schmidt, Ulrike, Oldershaw,
Anna, Jichi, Fatima, Sternheim, Lot, Startup, Helen, McIntosh, Virginia, Jordan, Jennifer, Tchanturia, Kate, Wolff, Geoffrey, Rooney, Michael, Landau, Sabine, Treasure, Janet
Background: Very limited evidence is available on how to treat adults with anorexia nervosa and
treatment outcomes are poor. Novel treatment approaches are urgently needed.; Aims: To evaluate the efficacy and acceptability of a novel
psychological therapy for anorexia nervosa (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) compared with specialist supportive
clinical management (SSCM) in a randomised controlled trial.; Method: Seventy-two adult out-patients with anorexia nervosa or eating disorder not
otherwise specified were recruited from a specialist eating disorder service in the UK. Participants were randomly allocated to 20 once weekly
sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need (trial registration: ISRCTN62920529). The primary
outcomes were body mass index, weight and global score on the Eating Disorders Examination at end of treatment (6 months) and follow-up (12 months).
Secondary outcomes included: depression, anxiety and clinical impairment; neuropsychological outcomes; recovery rates; and additional service
utilisation.; Results: At baseline, patients randomised to MANTRA were significantly less likely to be in a partner relationship than those receiving
SSCM (3/34 v. 10/36; P<0.05). Patients in both treatments improved significantly in terms of eating disorder and other outcomes, with no
differences between groups. Strictly defined recovery rates were low. However, MANTRA patients were significantly more likely to require additional
in-patient or day-care treatment than those receiving SSCM (7/34 v. 0/37; P = 0.004).; Conclusions: Adults with anorexia nervosa are a difficult to
treat group. The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM. This study confirms
SSCM as a useful treatment for out-patients with anorexia nervosa. The novel treatment, MANTRA, designed for this patient group may need adaptations
to fully exploit its potential.;
British Journal of Psychiatry, 201(5) : 392-
399
- Year: 2012
- Problem: Anorexia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Stiles-Shields, Colleen, Hoste, Renee Rienecke, Doyle, Peter M., le Grange, Daniel
This review focuses on the use of family-based treatment (FBT)
for adolescents with eating disorders, including anorexia nervosa (AN) and bulimia nervosa (BN). AN and BN are serious disorders with significant
psychiatric and medical morbidity. Data support the use of family treatments for adolescents with eating disorders. Developed at the Maudsley
Hospital, FBT is a theoretically agnostic approach that externalizes the illness from the patient and empowers families to actively work to bring
about recovery in their relative with an eating disorder. FBT appears to be an effective treatment for adolescents with AN and support is developing
for the treatment of adolescents with BN. Manual development is currently underway for the implementation of FBT for young adults with eating
disorders, overweight adolescents, and those with subsyndromal AN. Further research is needed to determine the effectiveness of FBT with other
populations. In this review, we will provide a critical overview of the literature by focusing upon empirical findings regarding FBT, with particular
emphasis on studies conducted with adolescents.;
Reviews on
Recent Clinical Trials, 7(2) : 133-140
- Year: 2012
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Fichter, Manfred M., Quadflieg, Norbert, Nisslmüller, Kerstin, Lindner, Susanne, Osen, Bernhard, Huber, Thomas, Wunsch-Leiteritz, Wally
Technological advancements allow new approaches to psychotherapy via electronic media. The eating disorder literature
currently contains no studies on internet intervention in anorexia nervosa (AN). This study presents a RCT on an internet-based relapse prevention
program (RP) over nine months after inpatient treatment for AN. The sample comprised 258 women, randomized to the RP or treatment as usual (TAU).
Expert- and self-ratings were evaluated by intent-to-treat analyses. Concerning age, age at onset and comorbidity, both groups were comparable at
randomization. During the RP, the intervention group gained weight while the TAU group had minimal weight loss. RP completers gained significantly
more body weight than patients in the TAU condition. Group-by-time comparisons for eating-related cognitions and behaviors and general
psychopathology showed a significantly more favorable course in the RP program for \"sexual anxieties\" and \"bulimic symptoms\" (interview), and
\"maturity fears\" and \"social insecurity\" (EDI-2). General psychopathology showed no significant group-by-time interaction. Important factors for
successful relapse prevention were adherence to the intervention protocol and increased spontaneity. Considering the unfavorable course and
chronicity of anorexia nervosa (AN), internet-based relapse prevention in AN following inpatient treatment appears a promising approach. Future
internet-based programs may be further improved and enhanced.; Copyright © 2012 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 50(3) : 180-
190
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS)
Godart, Nathalie, Berthoz, Sylvie, Curt, Florence, Perdereau, Fabienne, Rein, Zoe, Wallier, Jenny, Horreard, Anne-Sophie, Kaganski, Irene, Lucet, Rejane, Atger, Frederic, Corcos, Maurice, Fermanian, Jacques, Falissard, Bruno, Flament, Martine, Eisler, Ivan, Jeammet,
Philippe
Unlabelled: Research on
treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in 'real world practice' in AN treatment resort to
multidisciplinary approaches, they have rarely been evaluated.; Objective: To compare two multidimensional post-hospitalization outpatients treatment
programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).; Method: Sixty female AN
adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until
2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions
for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but
also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan
and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences
(eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not
participants, were blind to randomization.; Results: At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome
category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p?=?0.05; Per Protocol analysis:
respectively 12/26 (46.2%); 4/27 (14.8%), p?=?0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI=10
(th) percentile) and menstrual status.; Conclusions: Adding family therapy sessions, focusing on intra-familial dynamics rather than eating
symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN.; Trial Registration: Controlled-trials.com
ISRCTN71142875.;
PLoS
ONE, 7(1) : e28249-e28249
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Flament, Martine F., Bissada,
Hany, Spettigue, Wendy
The objective was to review scientific evidence for efficacy
and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials
(RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for
which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical
antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-
patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of
BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically
significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one
serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically
significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for
medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus
psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone.
Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the
clinician.;
International Journal of Neuropsychopharmacology, 15(2) : 189-
207
- Year: 2012
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Faje, Alexander T., Fazeli, Pouneh K., Katzman, Debra K., Miller, Karen K., Breggia, Anne, Rosen, Clifford J., Mendes, Nara, Klibanski,
Anne, Misra, Madhusmita
Sclerostin, product of the SOST gene,
is an important determinant of bone formation and resorption. Adolescents with anorexia nervosa (AN) have low bone density and decreased levels of
bone turnover markers. However, sclerostin has not been examined in AN as a potential mediator of impaired bone metabolism. Our study objectives were
to (i) assess associations of sclerostin with surrogate bone turnover markers in girls with AN and controls and (ii) examine effects of transdermal
estradiol on sclerostin in AN. 69 girls (44 with AN and 25 normal-weight controls) 13-18 years old were studied at baseline. 22 AN girls were
randomized to transdermal estradiol (plus cyclic medroxyprogesterone) or placebo in a double-blind study for 12 months. Sclerostin correlated
positively with P1NP and CTX in controls (r=0.67 and 0.53, p=0.0002 and 0.005, respectively) but not in AN despite comparable levels at baseline.
Changes in sclerostin over twelve months did not differ in girls randomized to estradiol or placebo. The relationship between sclerostin and bone
turnover markers is disrupted in adolescent girls with AN. Despite an increase in BMD with estradiol administration in AN, estrogen does not impact
sclerostin levels in this group.; Copyright © 2012 Elsevier Inc. All rights reserved.
Bone, 51(3) : 474-
479
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Faje, A. T., Fazeli, P., Katzman, D. K., Miller, K. K., Breggia, A., Rosen, C. J., Mendes, N., Misra, M., Klibanski, A.
Regulation of mesenchymal stem cell (MSC)
differentiation into the osteoblast or the adipocyte lineage may influence bone formation. Adolescents with anorexia nervosa (AN) have low bone
mineral density (BMD) and decreased bone formation. Preadipocyte factor 1 (Pref-1), an inhibitor of adipocyte and osteoblast differentiation, is
elevated in states of estrogen deficiency and may negatively affect BMD in adolescent girls with AN.Objective: To (i) compare levels of Pref-1 in
adolescent girls with AN and controls, (ii) investigate the effects of transdermal estradiol on Pref-1 in AN, and (iii) examine associations of
changes in Pref-1 with changes in lumbar BMD and markers of bone turnover.Design and Methods: Sixty-nine girls (44 with AN and 25 normal-weight
controls) 13-18 years of age were studied at baseline. Subjects were selected from a prior study based on their lumbar spine BMD Z-scores. The subset
included all subjects with AN who had a baseline lumbar BMD Z-score less than -0.5 and normal-weight controls with lumbar BMD Z-scores between +1.0
and -1.0. Twenty-two AN girls with a bone age of (greater-than or equal to) 15 years were randomized to 100mcg transdermal estradiol (n = 13) or
placebo (n = 9) in a double-blind study for 12 months. Subjects randomized to transdermal estradiol received medroxyprogesterone 2.5mg daily for 10
days each month. All subjects also received calcium carbonate (1200mg) and vitamin D (400 IU) daily. Results: Although Pref-1 levels did not differ
in AN versus controls (0.246 (plus or minus) 0.015 vs. 0.267 (plus or minus) 0.022 ng/ml, p = 0.46) at baseline, levels significantly decreased in
girls with AN after treatment with transdermal estradiol compared with placebo (-0.015 (plus or minus) 0.016 vs. 0.060 (plus or minus) 0.026 ng/ml, p
= 0.02). Changes in Pref-1 over twelve months correlated inversely with changes in lumbar BMD (r = -0.48, p = 0.02) and positively with changes in
CTX (r = 0.73, p = 0.01). Levels of Pref-1 were inversely associated with estradiol levels in subjects with AN (r = -0.67, p = 0.004) after 12 months
of treatment with transdermal estradiol or placebo. Conclusion s: One year of estrogen replacement suppresses Pref-1 in girls with AN. Additionally,
Pref-1 levels correlate inversely with changes in BMD and positively with changes in CTX, a marker of bone resorption. Inhibition of Pref-1 may in
part mediate the beneficial effects of transdermal estradiol replacement on bone mass in adolescent girls with AN.
Endocrine
Reviews, 33(3) :
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Divasta, Amy D., Feldman, Henry A., Giancaterino, Courtney, Rosen, Clifford
J., Leboff, Meryl S., Gordon, Catherine M.
Anorexia nervosa (AN) is characterized by subnormal estrogen and dehydroepiandrosterone (DHEA) levels. We
sought to determine whether the combination of DHEA + estrogen/progestin is superior to placebo in preserving skeletal health over 18 months in AN.
Females with AN, aged 13 to 27 years, were recruited for participation in this double-blind, placebo-controlled, randomized trial. Ninety-four
subjects were randomized, of whom 80 completed baseline assessments and received either study drug (oral micronized DHEA 50 mg + 20 µg ethinyl
estradiol/0.1 mg levonorgestrel combined oral contraceptive pill [COC] daily; n = 43) or placebo (n = 37). Serial measurements of areal bone mineral
density (aBMD), bone turnover markers, and serum hormone concentrations were obtained. Sixty subjects completed the 18-month trial. Spinal and
whole-body aBMD z scores were preserved in the DHEA + COC group, but decreased in the placebo group (comparing trends, P = .008 and P = .001,
respectively). Bone turnover markers initially declined in subjects receiving DHEA + COC and then returned to baseline. No differences in body
composition, adverse effects of therapy, or alterations in biochemical safety parameters were observed. Combined therapy with DHEA + COC appears to
be safe and effective for preventing bone loss in young women with AN, whereas placebo led to decreases in aBMD. Dehydroepiandrosterone + COC may be
safely used to preserve bone mass as efforts to reverse the nutritional, psychological, and other hormonal components of AN are implemented.;
Copyright © 2012 Elsevier Inc. All rights reserved.
Metabolism: Clinical &
Experimental, 61(7) : 1010-1020
- Year: 2012
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions