Disorders - Anorexia Nervosa
Bergh, C., Brodin, U., Lindberg, G., Sodersten, P.
Evidence for the effectiveness of existing
treatments of patients with eating disorders is weak. Here we describe and evaluate a method of treatment in a randomized controlled trial. Sixteen
patients, randomly selected out of a group composed of 19 patients with anorexia nervosa and 13 with bulimia nervosa, were trained to eat and
recognize satiety by using computer support. They rested in a warm room after eating, and their physical activity was restricted. The patients in the
control group (n = 16) received no treatment. Remission was defined by normal body weight (anorexia), cessation of binge eating and purging
(bulimia), a normal psychiatric profile, normal laboratory test values, normal eating behavior, and resumption of social activities. Fourteen
patients went into remission after a median of 14.4 months (range 4.9-26.5) of treatment, but only one patient went into remission while waiting for
treatment (P = 0.0057). Relapse is considered a major problem in patients who have been treated to remission. We therefore report results on a total
of 168 patients who have entered our treatment program. The estimated rate of remission was 75%, and estimated time to remission was 14.7 months
(quartile range 9.6 [greater-than or equal to]32). Six patients (7%) of 83 who were treated to remission relapsed, but the others (93%) have remained
in remission for 12 months (quartile range 6-36). Because the risk of relapse is maximal in the first year after remission, we suggest that most
patients treated with this method recover.
Proceedings of the National Academy
of Sciences of the United States of America., 99(14) : 9486-
9491
- Year: 2002
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Fassino, Secondo, Leombruni, Paolo, Daga, Giovanni Abbate, Brustolin, Annalisa, Migliaretti, Giuseppe, Cavallo, Franco, Rovera, Giovanni
G.
Anorexia nervosa (AN) still lacks a defined treatment. Since fluoxetine proved effective in
weight-restored anorexics, this pilot study evaluates the efficacy of another SSRI, citalopram, in restricting-type AN. 52 female anorectic
outpatients were randomized in the citalopram (n=26) and waiting list (n=26) as a control group. Efficacy was assessed using Eating Disorder
Inventory-2 (EDI-2), Eating Disorder Inventory-Symptom Checklist, State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI),
Symptom Checklist-90 (SCL-90)and Structured Clinical Interview for DSM-IV Axis II Disorders. 13 patients dropped-out, thus 19 patients received
citalopram and 20 remained in the control group. After 3 months of treatment, the citalopram group showed a decrease on BDI and SCL-90 Depression
subscale and an improvement of baseline obsessive compulsive features on SCL-90, EDI-2 impulsiveness and Trait-anger on STAXI. Weight gain was
similar in the two groups. These preliminary results support the efficacy of citalopram in anorectics. Citalopram seems to improve depression,
obsessive-compulsive symptoms, impulsiveness and Trait-anger. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
European Neuropsychopharmacology, 12(5) : 453-
459
- Year: 2002
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Dare, Chris, Eisler, Ivan, Russell, Gerald, Treasure, Janet, Dodge, Liz
Background
Currently, without systematic evidence, psychotherapy for anorexia nervosa in adults draws on psychodynamic, cognitive and systemic theories.Aims To
assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa.Method Eighty-four patients were
randomised to four treatments: three specific psychotherapies — (a) a year of focal psychoanalytic psychotherapy; (b) 7 months of cognitive
—analytic therapy (CAT); (c) family therapy for 1 year — and (d) low contact, ‘routine’ treatment for 1 year (control).Results At 1 year,
there was symptomatic improvement in the whole group of patients. This improvement was modest, several patients being significantly undernourished at
follow-up. Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment; CAT tended to show
benefits.Conclusions Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia.
British Journal of
Psychiatry, 178(3) : 216-221
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Psychodynamic/Psychoanalysis, Cognitive analytic therapy (CAT)
Ruggiero, G. M., Laini, V., Mauri, M. C., Ferrari, V. M. S., Clemente, A., Lugo,
F., Mantero, M., Redaelli, G., Zappulli, D., Cavagnini, F.
1. The
study evaluated the efficacy of amisulpride, fluoxetine and clomipramine at the beginning of the re-feeding phase of the treatment of restricting
anorexia nervosa according to DSM-IV criteria. 2. 13 patients, mean weight 37.61 kg +/- 9.80 SD, were treated with clomipramine at a mean dosage of
57.69 mg +/- 25.79 SD; 10 patients, mean weight 40.90 kg +/- 6.98 SD, were treated with fluoxetine at a mean dosage of 28.00 mg +/- 10.32 SD; 12
patients, mean weight 38.41 kg +/- 8.33 SD, were treated with amisulpride at a mean dosage of 50.00 mg +/- 0.00 SD. 3. Clinical evaluation was
carried out under single-blind condition at basal time and after three months by a structured clinical interview, the Eating Disorder Interview based
on Long Interval Follow-up Evaluation (LIFE II BEI). 4. Patients treated with amisulpride showed a more significant increase (p=O.O16) of mean
weight. Concerning weight phobia, body image disturbance and amenorrhoea, no significant difference resulted.
Progress in Neuro-Psychopharmacology & Biological Psychiatry., 25(5) : 1049-
1059
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Atypical Antipsychotics (second
generation)
Santonastaso, Paolo, Friederici, Silvia, Favaro, Angela
Conducted an open, controlled trial of sertraline in a sample of 11 restricting-type anorexics, treated in an
outpatient setting, compared with a control group of patients with similar characteristics (all Ss aged 14-34 yrs). All Ss were assessed by means of
a structured interview and self-reported questionnaires at baseline and after 14 wks of treatment. Body weight and diagnostic status were evaluated
again after a 64-wk follow-up. At the 14-wk follow-up, the sertraline group reported a significantly greater improvement of depressive symptoms,
ineffectiveness, lack of interoceptive awareness, and perfectionism when compared to the control group. Both groups reported a significant
improvement in body weight. At the 64-wk follow-up, only 1 patient of the sertraline group and 5 patients of the control group still had a full
diagnosis of an eating disorder. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Child & Adolescent Psychopharmacology, 11(2) : 143-
150
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Kaye, Walter H., Nagata, Toshihiko, Weltzin, Theodore E., Hsu, L., Sokol, Mae S., McConaha, Claire, Plotnicov, Katherine H., Weise, Jeff, Deep, Dianne
Anorexia nervosa is an often chronic disorder with high morbidity and mortality. Many people relapse after weight
restoration. This study was designed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after
weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms. The authors administered a double-blind
placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa. Anorexics were randomly assigned to fluoxetine (n=16)
or a placebo (n=19) after inpatient weight gain and then were observed as outpatients for 1 year. Ten of 16 (63%) Ss remained on fluoxetine for a
year, whereas only three of 19 (16%) remained on the placebo for a year. Those Ss remaining on fluoxetine for a year had reduced relapse as
determined by a significant increase in weight and reduction in symptoms. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Biological Psychiatry, 49(7) : 644-652
- Year: 2001
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Eisler, Ivan, Dare, Christopher, Hodes, Matthew, Russell, Gerald, Dodge, Elizabeth, Le Grange, Daniel
Reports the results of a randomized treatment trial of 2 forms of outpatient family
intervention for anorexia nervosa. 40 adolescent patients (aged 11-17 yrs) with anorexia nervosa were randomly assigned to conjoint family therapy
(CFT) or to separated family therapy (SFT) using a stratified design controlling for levels of critical comments using the Expressed Emotion index.
Measures were undertaken on admission to the study, at 3 mo, at 6 mo, and at the end of treatment. Considerable improvement in nutritional and
psychological state occurred across both treatment groups. On global measure of outcome, the 2 forms of therapy were associated with equivalent end
of treatment results. However, for those patients with high levels of maternal criticism towards the patient, the SFT was shown to be superior to the
CFT. When individual status measures were explored, there were further differences between the treatments. Symptomatic change was more marked in the
SFT whereas there was considerably more psychological change in the CFT group. There were significant changes in family measures of Expressed
Emotion. Critical comments between parents and patient were significantly reduced and that between parents was also diminished. Warmth between
parents increased. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal of Child Psychology & Psychiatry, 41(6) : 727-736
- Year: 2000
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Geist, R., Heinmaa, M., Stephens, D., Davis, R., Katzman, D. K.
OBJECTIVE: To compare the effects of 4 months of 2 family-oriented treatments, family therapy and family psychoeducation, on female
adolescents with newly diagnosed restrictive eating disorders. METHOD: Twenty-five female adolescents requiring hospitalization were randomized into
either family therapy or family group psychoeducation. Outcome measures included medical (body weight) and psychosocial (specific and nonspecific
eating disorder psychopathology) variables at baseline and after 4 months of treatments every 2 weeks. RESULTS: A significant time effect was found
in both treatment groups for the restoration of body weight (percentage of ideal body weight, P < 0.00001). The group averages ranged from 75% to 77%
ideal body weight before treatment to 91% to 96% after it. A time effect was also seen on the Family Assessment Measure (P < 0.018), in that the
patients of both groups acknowledged more family psychopathology at the end of treatment. No significant group differences were found on any of the
self-report measures of specific and nonspecific eating disorder pathology. CONCLUSIONS: Weight restoration was achieved following the 4-month period
of treatment in both the family therapy and family psychoeducation groups, but no significant change was reported in psychological functioning by
either adolescents or parents. Family group psychoeducation, the less expensive form of treatment, is an equally effective method of providing
family-oriented treatment to newly diagnosed, medically compromised anorexia nervosa patients and their families.
Canadian Journal of
Psychiatry, 45(2) : 173-8
- Year: 2000
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Psychoeducation
Bachar, Eytan, Latzer, Yael, Kreitler, Shulamit, Berry, Elliot M.
The authors investigated the
applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. 33 female
patients (mean age 24 yrs) participated in this study. The bulimic patients (N=25) were randomly assigned either to SPT, COT, or control/nutritional
counseling only (C/NC). The anorexic patients (N=8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome
measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant
improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected. (PsycINFO
Database Record (c) 2008 APA, all rights reserved).
Psychotherapy Practice & Research, 8(2) : 115-128
- Year: 1999
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Robin,
Arthur L., Siegel, Patricia T., Moye, Ann W., Gilroy, Marcia, Dennis, Amy Baker, Sikand, Anju
Compared the effectiveness of behavioral family systems therapy (BFST) with
that of ego-oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. 37 females (aged 11-20 yrs) with anorexia nervosa
were randomly assigned to receive BFST or EOIT, in addition to a common medical and dietary regimen. In BFST, the family was seen conjointly, the
parents were placed in control of the adolescent's eating, distorted beliefs were targeted through cognitive restructuring, and strategic/behavioral
interventions were used to change family interactions. In EOIT, the adolescent was seen individually, with an emphasis on building ego strength and
uncovering the dynamics blocking eating; parents were seen collaterally. Measures administered before, after, and at 1-yr follow-up tapped body mass
index, menstruation, eating attitudes, ego functioning, depression, and family interactions. BFST produced greater weight gain and higher rates of
resumption of menstruation than EOIT. Both treatments produced comparably large improvements in eating attitudes, depression, and eating-related
family conflict, but very few changes occurred on ego functioning. BFST and EOIT proved to be effective treatments, but BFST produced a faster return
to health. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
Journal
of the American Academy of Child & Adolescent Psychiatry, 38(12) : 1482-1489
- Year: 1999
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Serfaty, Marc A., Turkington, Douglas, Heap,
Michael, Ledsham, Lynne, Jolley, Elizabeth
Cognitive therapy has been used in anorexia
nervosa, but little is known about its effectiveness. A randomized controlled trial was undertaken comparing dietary advice with cognitive therapy in
the outpatient treatment of anorexia nervosa. Thirty-five patients were randomly allocated to either cognitive therapy (n=25) or dietary advice
(n=10). There were no significant differences in the groups pre-treatment. Twenty sessions of cognitive therapy or dietary advice were offered.
Results showed that at 6 mo, 23 cognitive therapy patients remained engaged whereas all the dietary advice controls dropped out. Cognitive therapy
patients showed significant changes in Body Mass Index (p=0.001), Eating Disorder Inventory Scores (p=0.035), Beck Depression Inventory Scores
(p<0.0001) and Locus of Control of Behaviour Scores (p=0.017). It is concluded that significant improvements were observed in patients allocated to
cognitive therapy, but not in those allocated to dietary advice on an intention to treat analysis. Cognitive therapy has advantages of promoting
engagement and facilitating recovery. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
European Eating Disorders Review, 7(5) : 334-350
- Year: 1999
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Dietary advice, dietary change
Attia, E., Haiman, C., Timothy Walsh, B., Flater, S. R.
Objective: While pharmacological
interventions are of established utility in bulimia nervosa, medications have no clear role in the treatment of anorexia nervosa. Because patients
with anorexia nervosa frequently exhibit mood disturbances and symptoms of obsessive-compulsive disorder, the authors tested the utility of
fluoxetine in the treatment of women participating in an inpatient program for anorexia nervosa. Method: The authors conducted a randomized,
placebo-controlled, double-blind, 7-week study of fluoxetine at a target daily dose of 60 mg in 31 women with anorexia nervosa receiving treatment
for their eating disorder on a clinical research unit. Body weight and measures of eating behavior and psychological state were obtained at baseline
and at termination. Results: There were no significant differences in clinical outcome on any measure between patients receiving fluoxetine and
patients receiving placebo. Conclusions: Fluoxetine does not appear to add significant benefit to the inpatient treatment of anorexia nervosa.
American Journal of
Psychiatry., 155(4) : 548-551
- Year: 1998
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)