Disorders - Anorexia Nervosa
Fisher, Caroline A., Hetrick, Sarah E., Rushford, Nola
Background: Objectives: Search Strategy: Selection Criteria:
Data Collection and Analysis: Main Results: Authors' Conclusions: Anorexia Nervosa (AN) is characterised by distorted body image and deliberately
maintained low body weight. The long term prognosis is often poor, with severe medical, developmental and psychosocial complications, high rates of
relapse and mortality. Different variants of family therapy have been commonly used for intervention.To evaluate the efficacy of family therapy
compared with standard treatment and other treatments.The Cochrane Collaboration Depression, Anxiety and Neuroses Controlled Trials Register
(CCDANCTR) was searched until August 2008; MEDLINE, PsycInfo and EMBASE and ClinicalTrials.gov were searched up to January 2008. A conference
abstract book and included studies reference lists were searched. All lead authors of included studies were also contacted.Randomised controlled
trials (RCTS) of interventions described as 'family therapy' compared to any other intervention or other types of family therapy were eligible for
inclusion. Patients of any age or gender with a primary clinical diagnosis of anorexia nervosa (AN) were included.Two review authors selected the
studies, assessed quality and extracted data. We used a random effects meta-analysis. Relative risk was used to summarise dichotomous outcomes and
both the standardised mean difference and mean difference to summarise continuous measures.13 trials were included, the majority investigating family
based therapy, or variants. Reporting of trial conduct was generally inadequate. The full extent of the risk of bias is unclear. There was some
evidence (from two studies, 81 participants) to suggest that family therapy may be more effective than treatment as usual on rates of remission, in
the short term (RR 3.83 95% CI 1.60 to 9.13). Based on one study (30 participants) there was no significant advantage for family therapy over
educational interventions (RR 9.00 95% CI 0.53, 153.79) or over other psychological interventions (RR 1.13 95% CI 0.72 to 1.76) based on four studies
(N=149).All other reported comparisons for relapse rates, cognitive distortion, weight measures and dropouts yielded non-significant results.There is
some evidence to suggest that family therapy may be effective compared to treatment as usual in the short term. However, this is based on few trials
that included only a small number of participants, all of which had issues regarding potential bias. There appears to be little advantage of family
therapy over other psychological interventions. The field would benefit from a large, well-conducted trial.
Cochrane
Database of Systematic Reviews, (4) : CD004780
- Year: 2010
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Fogarty,
S., Harris, D., Zaslawski, C., McAinch, A. J., Stojanovska, L.
Objective: This study
examines the role of acupuncture as an adjunct therapy in the treatment of eating disorders in female patients. Design: A randomised cross-over study
was used in this study. The two treatments phases were the private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia,
only (referred to as their treatment as usual) and a continuation of their treatment as usual supplemented by acupuncture. Participants: Patients
receiving treatment at a private multi-disciplinary outpatient eating disorder facility in Melbourne, Australia were asked to participate in the
study. Nine consenting women (5 with Anorexia Nervosa, 4 with Bulimia Nervosa), aged (mean and SD) 23.7 (9.6) years, participated in the study. Main
outcome measures: The main outcome measure was the Eating Disorder Inventory-3. Secondary outcome measures were the Becks Depression Inventory-2,
State Trait Anxiety Inventory and the Eating Disorder Quality of Life Scale. Results: There was evidence that acupuncture improved the participants'
Quality of Life as measured by the physical/cognitive and psychological components of the Eating Disorder Quality of Life scale. There was also
evidence of decreases in anxiety (both State and Trait as measured by the State Trait Anxiety Intervention) and perfectionism (as measured by the
Eating Disorder Inventory-3). Conclusion: This pilot study shows potential of the benefit of acupuncture as an adjunct therapy in the treatment of
eating disorders particularly in the area of quality of life. (copyright) 2010.
Complementary Therapies in Medicine, 18(6) : 233-240
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Acupuncture, acupressure
Carei, T. Rain, Fyfe-Johnson, Amber L., Breuner, Cora C., Brown,
Margaret A.
Purpose: Methods: Results: Conclusions: This was a pilot project designed to assess the effect of
individualized yoga treatment on eating disorder outcomes among adolescents receiving outpatient care for diagnosed eating disorders (anorexia
nervosa, bulimia nervosa, eating disorder not otherwise specified).A total of 50 girls and 4 boys aged 11-21 years were randomized to an 8-week trial
of standard care vs. individualized yoga plus standard care. Of these, 27 were randomized to standard care and 26 to yoga plus standard care
(attrition: n = 4). Standard care (every other week physician and/or dietician appointments) was required to meet ethical guidelines. The No Yoga
group was offered yoga after study completion as an incentive to maintain participation. Outcomes evaluated at baseline, end of trial, and 1-month
follow-up included Eating Disorder Examination (EDE), Body Mass Index (BMI), Beck Depression Inventory, State-Trait Anxiety Inventory, and Food
Preoccupation questionnaire.The Yoga group demonstrated greater decreases in eating disorder symptoms. Specifically, the EDE scores decreased over
time in the Yoga group, whereas the No Yoga group showed some initial decline but then returned to baseline EDE levels at week 12. Food preoccupation
was measured before and after each yoga session, and decreased significantly after all sessions. Both groups maintained current BMI levels and
decreased in anxiety and depression over time.Individualized yoga treatment decreased EDE scores at 12 weeks, and significantly reduced food
preoccupation immediately after yoga sessions. Yoga treatment did not have a negative effect on BMI. Results suggest that individualized yoga therapy
holds promise as adjunctive therapy to standard care.; Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights
reserved.
Journal of Adolescent Health, 46(4) : 346-351
- Year: 2010
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Mind-body exercises (e.g. yoga, tai chi, qigong)
Carter, Jacqueline C., McFarlane, Traci L., Bewell, Carmen, Olmsted, Marion P., Woodside, D. Blake, Kaplan, Allan S., Crosby, Ross D.
Objective: Method:
Results: Discussion: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual
cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU).This study was a nonrandomized clinical trial. The participants were 88
patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a
specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control
condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed
at 3-month intervals during the 1-year study. The main outcome variable was time to relapse.When relapse was defined as a BMI
International Journal of Eating Disorders, 42(3) : 202-207
- Year: 2009
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wade, Tracey D., Frayne, Anna, Edwards, Sally-Anne, Robertson, Therese, Gilchrist, Peter
Objective: Method: Results: Conclusions: The relationship between motivation and recovery in anorexia
nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this
population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in
eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group?
Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of
motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating
pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was
assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire
and six Likert scales.Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased
Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology
between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational
interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to
change at 2 and 6 week follow up.Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that
motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be
conducted, along with the impact of motivational changes on treatment outcome.
Australian & New Zealand Journal of Psychiatry, 43(3) : 235-
243
- Year: 2009
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Korrelboom, Kees, de Jong, Martie, Huijbrechts, Irma, Daansen, Peter
This study
evaluates a short stepwise cognitive-behavioral intervention for the treatment of low self-esteem in patients with eating disorders. Competitive
memory training (COMET) for low self-esteem is based on insights and findings from experimental psychology. A total of 52 patients with eating
disorders and low self-esteem were treated with COMET in a routine mental health center in addition to their regular treatment. These patients were
randomized to receive 8 weeks of COMET + therapy as usual (TAU) or to receive TAU only. Differential effects in favor of COMET + TAU were found for 2
indexes of self-esteem and for 1 index of depressive mood. Shortcomings of this study and possible clinical implications are discussed.; (c) 2009
APA, all rights reserved.
Journal of Consulting & Clinical
Psychology, 77(5) : 974-980
- Year: 2009
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Bissada,
H., Tasca, G. A., Barber, A. M., Bradwejn, J.
Objective: Anorexia nervosa is associated with high mortality, morbidity, and treatment costs. Olanzapine, an atypical antipsychotic, is
known to result in weight gain in other patient populations. The objective of this trial was to assess the efficacy of olanzapine in promoting weight
gain and in reducing obsessive symptoms among adult women with anorexia nervosa. Method: The study was a double-blind, placebo-controlled, 10-week
flexible dose trial in which patients with anorexia nervosa (N=34) were randomly assigned to either olanzapine plus day hospital treatment or placebo
plus day hospital treatment. Results: Compared with placebo, olanzapine resulted in a greater rate of increase in weight, earlier achievement of
target body mass index, and a greater rate of decrease in obsessive symptoms. No differences in adverse effects were observed between the two
treatment conditions. Conclusions: These preliminary results suggest that olanzapine may be safely used in achieving more rapid weight gain and
improvement in obsessive symptoms among women with anorexia nervosa. Replication, in the form of a large multicenter trial, is recommended.
American Journal of Psychiatry, 165(10) : 1281-1288
- Year: 2008
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Bloomgarden, A., Calogero, R. M.
Eye Movement Desensitization and Reprocessing (EMDR) therapy is
being used by some clinicians to treat eating disorders. Although there is anecdotal and case study data supporting its use, there are no controlled
studies examining its effectiveness with this population. This study examined the short and long-term effects of EMDR in a residential eating
disorders population. A randomized, experimental design compared 43 women receiving standard residential eating disorders treatment (SRT) to 43 women
receiving SRT and EMDR therapy (SRT+EMDR) on measures of negative body image and other clinical outcomes. SRT+EMDR reported less distress about
negative body image memories and lower body dissatisfaction at posttreatment, 3-month, and 12-month follow-up, compared to SRT. Additional
comparisons revealed no differences between the conditions pre to posttreatment on other measures of body image and clinical outcomes. The empirical
evidence reported here suggests that EMDR may be used to treat specific aspects of negative body image in conjunction with SRT, but further research
is necessary to determine whether or not EMDR is effective for treating the variety of eating pathology presented by eating disorder inpatients.
Eating Disorders., 16(5) : 418-
427
- Year: 2008
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Eye movement desensitisation and reprocessing (EMDR)
Court, A., Mulder, C., Hetrick,
Sarah E., Purcell, R., McGorry, P. D.
This systematic review assesses the effectiveness of
antipsychotic\rmedication for improving core psychopathology and behavioral\rsymptoms of anorexia nervosa. The Cochrane Depression, Anxiety\rand
Neurosis Group Trials Register, reference lists of retrieved studies\rand conference abstracts were searched. Four randomized controlled\rtrials
comparing typical or atypical antipsychotic medication to other\rinterventions were included. Clinical heterogeneity precluded metaanalysis.
\rOverall, there is insufficient evidence to either support or\rrefute the use of antipsychotic medication in anorexia nervosa.\rFurther trials may
be justified but should be designed with a clear\rtheoretical framework to guide use of antipsychotic medication.
Eating
Disorders, 16(3) : 217-223
- Year: 2008
- 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)
Fichter, M., Cebulla, M., Quadflieg, N., Naab, S.
The goal of this study was
to develop a cognitive-behavioral self-help manual for anorexia nervosa. Patients diagnosed with anorexia nervosa (N =102), binge eating/purging type
(AN-B/P), were consecutively assigned to one of two conditions: 6-week manualized guided self-help or a wait-list control. All patients thereafter
received inpatient treatment in a hospital for behavioral medicine. The primary outcome variable was the number of days in inpatient treatment.
Secondary outcome variables were measures of psychopathology. Results showed that duration of inpatient treatment was significantly shorter (by 5.2
days) among participants receiving guided self-help. Body image, slimness ideal, general psychopathology, and some bulimic symptoms improved
significantly during self-help. The authors conclude that, to increase effects of therapist-guided self-help in AN-B/P, additional variants of a
self-help manual should be tried in different therapeutic settings.
Psychotherapy
Research., 18(5) : 594-603
- Year: 2008
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Self-help
Eisler,
Ivan, Simic, Mima, Russell, Gerald F. M., Dare, Christopher
BACKGROUND: There is growing
evidence that family therapy is an effective treatment for adolescent anorexia nervosa. This study aimed to ascertain the long-term impact of two
forms of outpatient family intervention previously evaluated in a randomised controlled trial (RCT). METHOD: A five-year follow-up was conducted on a
cohort of 40 patients who had received either 'conjoint family therapy' (CFT) or 'separated family therapy' (SFT). All patients were traced and
38 agreed to be reassessed (29 interviewed in person, 3 completed telephone interviews, 6 completed questionnaires and/or agreed for parents/GP to be
interviewed). RESULTS: Overall there was little to distinguish the two treatments at 5 years, with more than 75% of subjects having no eating
disorder symptoms. There were no deaths in the cohort and only 8% of those who had achieved a healthy weight by the end of treatment reported any
kind of relapse. Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa. The one difference
between the treatments was in patients from families with raised levels of maternal criticism. This group of patients had done less well at the end
of treatment if they had been offered conjoint family meetings. At follow-up this difference was still evident, as shown in the relative lack of
weight gain since the end of outpatient treatment. CONCLUSIONS: This study confirms the efficacy of family therapy for adolescent anorexia nervosa,
showing that those who respond well to outpatient family intervention generally stay well. The study provides further support for avoiding the use of
conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident.
Journal of Child Psychology & Psychiatry, 48(6) : 552-
60
- Year: 2007
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Couturier, J., Lock, J.
Objective: This paper aims to review the research literature on the use
of medication for eating disorders in children and adolescents. Method: The literature was reviewed on the pharmacotherapy of anorexia nervosa (AN),
bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). The PubMed database was searched for all articles on medication use in the
child and adolescent population using the terms medication, antipsychotic, antidepressant, child, adolescent, eating disorders, anorexia nervosa and
bulimia nervosa. Results: Very little literature exists on the use of medication for the treatment of eating disorders in children and adolescents.
There is one retrospective study on the use of SSRIs and some case reports on atypical antipsychotics for children and adolescents with AN, and one
small open trial on SSRIs for adolescent BN. Conclusions: Evidence-based pharmacological treatment for children and adolescents with eating disorders
is not yet possible due to the limited number of studies available, It appears that olanzapine and other atypical antipsychotics may prove to be
promising for AN at low body weights. It remains uncertain whether SSRIs are helpful in preventing relapse in AN. For children and adolescents with
BN, the first line pharmacological option is fluoxetine given the large evidence base of this drug with the adult population and a small open trial
of adolescents with BN.
Canadian Child
& Adolescent Psychiatry Review, :
- Year: 2007
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)