Disorders - Anorexia Nervosa
Stiles-Shields, C., Smyth, A., Glunz, C., Hoste, R. R., Boepple, L., le Grange, D.
Eating disorders frequently have their onset in adolescence. This is problematic as
Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorder Not Otherwise Specified (EDNOS) often present with serious psychiatric and medical
sequelae that can affect an adolescent's physical and emotional development. It is well documented that complications from eating disorders in
adolescence can result in long-term health consequences, rendering effective psychiatric and medical treatments a necessity. To combat the medical
consequences associated with eating disorders in adolescents, pediatricians must identify, treat, and monitor medical complications. Pediatricians
are also responsible for assessing the need for hospitalization due to medical instability. Some advances have been made regarding
psychopharmacological treatments for eating disorders. For example, antidepressant medications, such as SSRIs, have demonstrated efficacy in the
treatment of adults with BN. The true effectiveness of these medications in adolescent populations remains unknown. A multidisciplinary team approach
is a common treatment model in outpatient practice, but further research is required to investigate how to facilitate the collaboration of
psychiatric and medical professionals. The majority of psychiatric and medical trials for eating disorder patients have involved adult participants,
and most studies have investigated either psychiatric or medical treatments for eating disorders. In this review, we will add to the current
literature by focusing on both psychiatric and medical treatments for eating disorders, with particular emphasis on studies conducted with
adolescents. (copyright) 2011 Bentham Science Publishers.
Current Psychiatry Reviews, 7(3) : 177-
188
- Year: 2011
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Smith, A., Cook-Cottone,
C.
This review examines family therapy as an
effective intervention for Anorexia Nervosa (AN) in adolescents. An electronic and manual literature search was conducted. Studies pertaining to
family therapy in the treatment of AN and specifically, the Maudsley Method/ Family-Based Treatment were identified. A limited number of randomized
control trials exist implicating family therapy. Of the existent studies, methodological limitations pertaining to small, homogeneous sample sizes
are evident. Despite the limited number of studies, family therapy appears to illustrate probable efficacy. Additional research and funding are
necessary to fully support family therapy in the treatment of AN in adolescents. (copyright) Springer Science+Business Media, LLC 2011.
Journal of Clinical Psychology in Medical Settings, 18(4) : 323-334
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Wick, K., Brix, C., Bormann, B., Sowa, M., Strauss, B., Berger, U.
Objective: Anorexia nervosa ('AN') is notoriously difficult to treat, has high
mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program ('PriMa') for the primary
prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls. Method: Intervention involved nine guided lessons
with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92
Thuringian schools (n=1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.
Results: After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d=.24) and body
self esteem (d=.29), but not for eating behavior. Conclusion: The PriMa intervention provides an efficient and practical model to increase AN-related
protection factors. (copyright) 2010 Elsevier Inc.
Preventive Medicine, 52(2) : 152-
158
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Hagman, J.: Gralla, J., Sigel, E., Ellert, S., Dodge, M., Gardner, R., O'Lonergan, T., Frank, G., Wamboldt, M. Z.
The purpose of this double-blind, placebo-controlled exploratory pilot study was to
evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa. Forty female subjects 12 to 21 years of age (mean, 16 years)
with primary anorexia nervosa in an eating disorders program were randomized to receive risperidone (n = 18) or placebo (n = 22). Subjects completed
the Eating Disorder Inventory 2, Color-A-Person Test, Body Image Software, and Multidimensional Anxiety Scale for Children at baseline and regular
intervals. Weight, laboratory values, and electrocardiograms were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly
in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint. The mean dose for the risperidone group was 2.5 mg and for
the placebo group was 3 mg for a mean duration of 9 weeks. Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2
Drive for Thinness subscale over the first 7 weeks (effect size, 0.88; p = .002), but this difference was not sustained to the end of the study (p =
.13). The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone (effect size, 0.60;
p = .03). Subjects taking risperidone had increased prolactin levels (week 7; p = .001). There were no significant differences between groups at
baseline or the end of the study for the other rating scales, change in weight, or laboratory measurements. This study does not demonstrate a benefit
for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care. Clinical trial registration
information-A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa, http://www.clinicaltrials.gov,
NCT00140426. Copyright (copyright) 2011 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Journal of the
American Academy of Child & Adolescent Psychiatry, 50(9) : 915-924
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Kafantaris, V., Leigh, E., Hertz,
S., Berest, A., Schebendach,
J., Sterling, W. M., Saito, E., Sunday, S., Higdon, C., Golden, N. H., Malhotra, A. K.
Objective: The objective of this study was to
explore whether the addition of olanzapine versus placebo increases weight gain and improves psychological symptoms in adolescents with anorexia
nervosa-restricting type who are participating in a comprehensive eating disorders treatment program. Methods: Twenty underweight females
participated in this 10-week, double-blind, placebo-controlled pilot study of olanzapine. The primary efficacy measure was change in percentage of
median body weight measured at baseline and weeks 5 and 10. Secondary efficacy measures included clinician-rated and self-reported measures of
psychological functioning measured at 2-week intervals and eating disorder symptoms measured at baseline and weeks 5 and 10 as well as laboratory
assessments (including indirect calorimetry), which were also performed at baseline and weeks 5 and 10. A mixed models approach to repeated measures
analysis of variance was utilized to detect any treatment-by-time interaction. Results: Fifteen of 20 enrolled females (median age, 17.1 years;
range, 12.3-21.8 years; mean body mass index, 16.3) completed this 10-week pilot study. Change in % median body weight did not differ between the
treatment groups at midpoint or end of study. Both groups gained weight at a similar rate and had similar improvements in eating attitudes and
behaviors, psychological functioning, and resting energy expenditure. A trend of increasing fasting glucose and insulin levels was found only in the
olanzapine group at week 10. Conclusions: These preliminary findings do not support a role for adjunctive olanzapine for underweight adolescent
females with anorexia nervosa-restricting type who are receiving standard care in an eating disorder treatment program (copyright) 2011, Mary Ann
Liebert, Inc.
Journal of Child & Adolescent Psychopharmacology, 21(3) : 207-
212
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Gardner, J., Wilkinson,
P.
Introduction:
Anorexia nervosa is a mental health disorder characterised by deliberate weight loss (through restrictive eating, excessive exercise and/or purging),
disordered body image, and intrusive overvalued fears of gaining weight. The National Institute for Clinical Excellence recommends that family
interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa. Aims: To perform a
literature review to assess whether family therapy is a more effective intervention than other treatments in the management of adolescents with
anorexia nervosa. Method: Search of PubMed, The Cochrane Library and NHS Evidence for randomised controlled trials that compared a family
intervention with another treatment for anorexia nervosa in adolescence. Results and discussion: This literature search revealed only six randomised
controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample
sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical
improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients. Due to the small
sample sizes and the significant risk of bias (particularly information bias) in some of the studies the evidence in favour of family therapy over
individual therapy is weak. In the future, larger randomised controlled trials with long term follow-up are required to assess whether family therapy
is the most effective treatment for anorexia nervosa in adolescence. (copyright) Medicinska naklada.
Psychiatria Danubina, 23(SUPPL. 1) : S175-S177
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Hartmann, Armin, Weber, Stefanie, Herpertz, Stephan, Zeeck,
Almut
Background: Methods: Results: Conclusion: For the German treatment guidelines for eating disorders, the literature on psychological
treatment of anorexia nervosa (AN) was reviewed systematically. As a common meta-analysis of randomized clinical trials proved to be impossible, a
review of all available clinical trials was conducted, statistically integrating standardized mean change scores. Research questions comprised
differential effects of therapeutic techniques and settings as well as determining which weight gains could be expected.After an extensive literature
search, studies were selected, rated by 3 independent raters. Weight gain as the main outcome criterion was transformed into standardized mean change
scores. Effect sizes were checked for homogeneity.57 studies containing 84 treatment arms and 2,273 patients could be integrated. Studies differed
considerably in quality. The strongest bias identified was reporting selectively on completers or failures, versus intention-to-treat samples. No
significant differences between effect sizes could be identified concerning treatment setting, technique or patient characteristics. If treatment
time is taken into account, inpatient treatment produced a faster weight gain than outpatient treatment.The study describes weight gains which can be
reached in outpatient and inpatient settings. It yielded no salient results speaking for a certain therapy technique, setting or procedure. Treatment
guidelines for psychological treatment of AN still have to rely on lower level evidence.\rCopyright © 2011 S. Karger AG, Basel.
Psychotherapy & Psychosomatics, 80(4) : 216-226
- Year: 2011
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Lock, James, Le
Grange, Daniel, Agras, W. Stewart, Moye, Ann, Bryson, Susan W., Jo, Booil
Context:
Objective: Design: Setting: Participants: Main Outcome Measures: Results: Conclusion: Trial Registration: Evidence-based treatment trials for
adolescents with anorexia nervosa are few.To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy
(AFT) for adolescents with anorexia nervosa in full remission.Randomized controlled trial.Stanford University and The University of Chicago (April
2005 until March 2009).One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the
amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline,
end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.Full remission from anorexia nervosa defined as normal weight (≥95%
of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures
included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile
and eating-related psychopathology.There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month
follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but
not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up.
Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-
up.Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective
in facilitating full remission at both follow-up points.clinicaltrials.gov Identifier: NCT00149786.
Archives of General Psychiatry, 67(10) : 1025-1032
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
McKnight, Rebecca F., Park, Rebecca J.
Background: Aims: Method: Results: Conclusions: There is
currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN).To evaluate the literature on the use of
atypical antipsychotics in AN.A review of all studies and clinical guidelines published before September 2009 involving use of an atypical
antipsychotic in patients with AN. Analysis is by narrative synthesis.Forty-three publications or study protocols were found, including four
randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone.
Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology
in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this
setting.Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to
persuade adequate numbers of AN patients to participate in research trials.
European Eating Disorders Review, 18(1) : 10-
21
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
delValle, Maria Fernandez, Perez, Margarita, Santana-Sosa, Elena, Fiuza-Luces, Carmen, Bustamante-Ara, Natalia, Gallardo,
Cristian, Villasenor, Angel, Graell, Montserrat, Morande, Gonzalo, Romo,
Gabriel R., Lopez-Mojares, Luis M., Ruiz, Jonatan R.
Purpose: Methods: Results: Conclusions: We determined the effects of a 3-month low-
moderate-intensity strength training program (2 sessions/week) on functional capacity, muscular strength, body composition, and quality of life (QOL)
in 22 young (12-16 yrs) anorexic outpatients.Patients were randomly assigned to a training or control group (n=11 [10 females] each). Training
sessions were of low intensity (loads for large muscle groups ranging between 20%-30% and 50%-60% of six repetitions maximum [6RM] at the end of the
program). We measured functional capacity by the time up and go and the timed up and down stairs tests. Muscular strength was assessed by 6RM
measures for seated bench and leg presses. We estimated percent body fat and muscle mass. We assessed patients' QOL with the Short Form-36 items.The
intervention was well tolerated and did not have any deleterious effect on patients' health, and did not induce significant losses in their body
mass. The only studied variable for which a significant interaction (group x time) effect was found (p=.009) was the 6RM seated lateral row
test.Low-moderate-intensity strength training does not seem to add major benefits to conventional psychotherapy and refeeding treatments in young
anorexic patients.; Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.
Journal of Adolescent Health, 46(4) : 352-358
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Court, A., Mulder, C., Kerr, M., Yuen, H. P., Boasman, M., Goldstone, S., Fleming, J., Weigall, S., Derham, H., Huang, C., McGorry, P., Berger, G.
To investigate the safety and tolerability of the atypical
antipsychotic quetiapine in anorexia nervosa patients, and to determine the effect of quetiapine treatment on anorexic psychopathology and other key
outcome measures including weight and body image, we conducted a naturalistic, open-label, 12-week randomized controlled trial of low-dose (100-400
mg/day) quetiapine treatment versus treatment as usual in 33 anorexia nervosa patients from our Eating Disorder Clinics. To monitor the effects of
treatment over the medium term, the participants were then followed up with assessment visits at 6 and 12 months after the end of the treatment
phase. Low-dose quetiapine treatment resulted in both psychological and physical improvements, with minimal associated side-effects. Given the
overall trend toward improvement that we observed, quetiapine appears to be a promising candidate for the treatment of anorexia nervosa. Further
large-scale placebo-controlled clinical trials will be necessary to fully evaluate the benefits of quetiapine treatment for this disorder.
(copyright) 2010 Elsevier Ltd.
Journal of Psychiatric Research, 44(15) : 1027-1034
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Gowers, S. G., Clark, A. F., Roberts, C., Byford, S., Barrett, B., Griffiths, A., Edwards, V., Bryan, C., Smethurst, N., Rowlands, L., Roots, P.
Objective: Design: Setting: Participants: Interventions: Main Outcome Measures: Results: Conclusion: Trial
Registration: To evaluate the clinical effectiveness and cost-effectiveness of inpatient compared with outpatient treatment and general (routine)
treatment in Child and Adolescent Mental Health Services (CAMHS) against specialist treatment for young people with anorexia nervosa. In addition, to
determine young people's and their carers' satisfaction with these treatments.A population-based, pragmatic randomised controlled trial (RCT) was
carried out on young people age 12 to 18 presenting to community CAMHS with anorexia nervosa.Thirty-five English CAMHS in the north-west of England
co-ordinated through specialist centres in Manchester and Liverpool.Two hundred and fifteen young people (199 female) were identified, of whom 167
(mean age 14 years 11 months) were randomised and 48 were followed up as a preference group.Randomised patients were allocated to either inpatient
treatment in one of four units with considerable experience in the treatment of anorexia nervosa, a specialist outpatient programme delivered in one
of two centres, or treatment as usual in general community CAMHS. The outpatient programmes spanned 6 months of treatment. The length of inpatient
treatment was determined on a case-by-case basis on clinical need with outpatient follow-up to a minimum of 6 months.Follow-up assessments were
carried out at 1, 2 and 5 years. The primary outcome measure was the Morgan-Russell Average Outcome Scale (MRAOS) and associated categorical
outcomes. Secondary outcome measures included physical measures of weight, height, body mass index (BMI) and % weight for height. Research ratings
included the Health of the National Outcome Scale for Children and Adolescents (HoNOSCA). Self report measures comprised the user version of HoNOSCA
(HoNOSCA-SR), the Eating Disorder Inventory 2 (EDI-2), the Family Assessment Device (FAD) and the recent Mood and Feelings Questionnaire (MFQ).
Information on resource use was collected in interview at 1, 2 and 5 years using the Child and Adolescent Service Use Schedule (CA-SUS). Satisfaction
was measured quantitatively using a questionnaire designed for the study and qualitative (free) responses on it. The questionnaire data were
supplemented by qualitative analysis of user and carer focus groups.Of the 167 patients randomised, 65% adhered to the allocated treatment. Adherence
was lower for inpatient treatment (49%) than for general CAMHS (71%) or specialist outpatient treatment (77%) (p = 0.013). Every subject was traced
at both 1 and 2 years, with the main outcome measure completed (through contact with the subject, family members or clinicians), by 94% at 1 year,
93% at 2 years, but only 47% at 5 years. A validated outcome category was assigned for 98% at 1 year, 96% at 2 years and 60% at 5 years. There was
significant improvement in all groups at each time point, with the number achieving a good outcome being 19% at 1 year, 33% at 2 years and 64% (of
those followed up) at 5 years. Analysis demonstrated no difference in treatment effectiveness of randomisation to inpatient compared with outpatient
treatment, or, specialist over generalist treatment at any time point, when baseline characteristics were taken into account. Generalist CAMHS
treatment was slightly more expensive over the first 2 years of the study, largely because greater numbers were subsequently admitted to hospital
after the initial treatment phase. The specialist outpatient programme was the dominant treatment in terms of incremental cost-effectiveness.
Specialist treatments had a higher probability of being more cost-effective than generalist treatments and outpatient treatment had a higher
probability of being more cost-effective than inpatient care. Parental satisfaction with treatment was generally good, though better with specialist
than generalist treatment. Young people's satisfaction was much more mixed, but again better with specialist treatment, including inpatient
care.Poor adherence to randomisation ( espite initial consent to it), limits the assessment of the treatment effect of inpatient care. However, this
study provides little support for lengthy inpatient psychiatric treatment on clinical or health economic grounds. These findings are broadly
consistent with existing guidelines on the treatment of anorexia nervosa, which suggest that outpatient treatments should be offered to the majority,
with inpatient treatment offered in rare cases, though our findings lend little support to a stepped-care approach in which inpatient care is offered
to outpatient non-responders. Outpatient care, supported by brief (medical) inpatient management for correction of acute complications may be a
preferable approach. The health economic analysis and user views both support NICE guidelines, which suggest that anorexia nervosa should be managed
in specialist services that have experience and expertise in its management. Comprehensive general CAMHS might, however, be well placed to manage
milder cases. Further research should focus on the specific components of outpatient psychological therapies. Although family-based treatments are
well established, trials have not established their effectiveness compared with good-quality individual psychological therapies and the combination
of individual and family approaches is untested. Further research is needed to establish which patients (if any) might respond to inpatient
psychiatric treatment when unresponsive to outpatient care, the positive and negative components of it and the optimum length of stay.NRR number
(National Research Register) N0484056615; Current Controlled Trials ISRCTN39345394.
Health Technology Assessment, 14(15) : 1-
98
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions