Disorders - Anorexia Nervosa
Biney, H., Giles, E., Hutt, M., Matthews, R., Lacey,
J. H.
Purpose: To
determine the potential effectiveness of a six-session manualised self-esteem group using CBT approaches when given as an adjuvant to adolescent
inpatients with Anorexia Nervosa (AN). Method(s): Using a randomised controlled design, 50 girls aged 12-17 years with AN were assigned to either
self-esteem group with treatment as usual (TAU) (n = 25) or TAU alone (n = 25). 50/78 (64%) consented to be randomised. Both groups completed self-
report measures of self-esteem and eating disorder psychopathology at three time points to measure the potential effectiveness of the treatment.
Qualitative feedback was collected to assess acceptability. Result(s): 29 participants completed the study: 15 self-esteem group with TAU, 14 TAU
alone. Self-esteem group participants had greater improvement in all outcomes than TAU participants at all time points, the difference in self-report
self-esteem at T2 is 1.12 (95% CI - 1.44-3.69; effect size = 0.21). Similar small effect sizes were found for the eating disorder psychopathology
measure following completion of the intervention but not at four-week follow-up. Favourable qualitative feedback was gained. Conclusion(s): These
findings demonstrate that the self-esteem group supplements an intensive treatment package which also addresses elements of low self-esteem. The
self-esteem group was beneficial for addressing self-esteem and acted as a catalyst for change in eating disorder psychopathology. Positive
qualitative feedback indicated the intervention was acceptable to users. Self-esteem group is a potential new adjuvant treatment for AN. EMB Rating:
Level 1. Copyright © 2021, Crown.
Eating and Weight Disorders., :
- Year: 2021
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Baumann, S., Mares, T., Albrecht, J., Anders, M., Vochoskova, K., Hill, M., Bulant, J., Yamamotova, A., Stastny, O., Novak, T., Holanova, P., Lambertova, A., Papezova, H.
Background: Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Although
transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear.
Objective(s): This study investigated changes in maladaptive eating behavior, body mass index (BMI), and depression after 10 sessions of anodal tDCS
over the left dorsolateral prefrontal cortex (DLPFC). Method(s): In this double-blind, randomized controlled trial, 43 inpatients with AN were
divided to receive either active (n = 22) or sham (n = 21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2 mA for 30 min). All patients filled the
Eating Disorder Examination Questionnaire (EDE-Q) and Zung Self-Rating Depression Scale (ZUNG), and their BMI was measured. These values were
obtained repeatedly in four stages: (1) before tDCS treatment, (2) after tDCS treatment, (3) in the follow-up after 2 weeks, and (4) in the follow-up
after 4 weeks. Result(s): Primary outcomes (EDE-Q) based on the ANOVA results do not show any between-group differences either after the active part
of the study or in the follow-up. Secondary analysis reveals a reduction in some items of EDE-Q. Compared with sham tDCS, active tDCS significantly
improved self-evaluation based on body shape (p < 0.05) and significantly decreased the need of excessive control over calorie intake (p < 0.05) in
the 4-week follow-up. However, the results do not survive multiple comparison correction. In both sham and active groups, the BMI values improved,
albeit not significantly. Conclusion(s): We did not observe a significant effect of tDCS over the left DLPFC on complex psychopathology and weight
recovery in patients with AN. tDCS reduced the need to follow specific dietary rules and improved body image evaluation in patients with AN. Tests
with a larger sample and different positions of electrodes are needed. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03273205.
© Copyright © 2021 Baumann, Mares, Albrecht, Anders, Vochoskova, Hill, Bulant, Yamamotova, Stastny, Novak, Holanova, Lambertova and Papezova.
Frontiers in Psychiatry, 12 (no pagination) :
- Year: 2021
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Other biological interventions
Baudinet, J., Eisler, I., Dawson, L., Simic, M., Schmidt, U.
OBJECTIVE: This study reviewed
the quantitative and qualitative evidence-base for multi-family therapy (MFT) for eating disorders regarding change in physical and psychological
symptoms, broader individual and family factors, and the experience of treatment.\rMETHOD: A systematic scoping review was conducted. Four databases
(PsycInfo, Medline, Embase, CENTRAL) and five grey literature databases were searched on 24th June 2021 for relevant peer-reviewed journal articles,
book chapters, and dissertations. No beginning time-point was specified. Only papers that presented quantitative or qualitative data were included.
No restrictions on age or diagnosis were imposed. Studies were first mapped by study design, participant age, and treatment setting, then narratively
synthesized.\rRESULTS: Outcomes for 714 people who received MFT across 27 studies (one mixed-method, 17 quantitative and nine qualitative) were
synthesized. MFT is associated with improvements in eating disorder symptomatology and weight gain for those who are underweight. It is also
associated with improvements in other individual and family factors including comorbidities, self-esteem, quality of life, and some aspects of the
experience of caregiving, although these findings are more mixed. MFT is generally experienced as both helpful and challenging due to the content
addressed and intensive group process.\rDISCUSSION: MFT is associated with significant improvements in eating disorder symptoms across the lifespan
and improvement in broader individual and family factors. The evidence base is small and studies are generally underpowered. Larger, higher-quality
studies are needed, as is research investigating the unique contribution of MFT on outcomes, given it is typically an adjunctive treatment.
International Journal of Eating Disorders, 54(12) : 2095-2120
- Year: 2021
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Other service delivery and improvement
interventions
Zeeck, Almut, Schlegel, Sabine, Jagau, Friederike, Lahmann,
Claas, Hartmann, Armin
Background: Unhealthy attitudes towards sport
and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is
a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg
sport therapy program for eating disorders (FSTP).\rMethods: Outpatients with ED were randomized either to a 3 month sport therapy program (sport
therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The
intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale,
CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive
Exercise Test, CET subscales) and exercise quantity (accelerometer).\rResults: Recruitment was challenging. Fifteen patients were randomized to the
STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome
criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG.
Improvements (STG) were maintained at follow up.\rConclusions: There was no statistically significant difference in the reduction of unhealthy
attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale.
Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major
limitation is the small sample size.
Journal of Eating Disorders Vol 8 2020, ArtID 31, 8 :
- Year: 2020
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Physical activity, exercise, Other service delivery and improvement
interventions
Rajagopalan, A. K.
Objectives: Anorexia nervosa (AN) is a DSM-5
feeding and eating disorder with high rates of mental health comorbidity, medical morbidity, and mortality. The primary modality of evidence-based
care is family-based treatment (FBT). Given the complexity and significant mental health comorbidities associated with AN, pharmacotherapy is often
sought out as adjunctive treatment. SSRIs have been studied with little support for their utilization in weight gain or maintenance. Antipsychotic
medications have also been studied, in part due to the cognitive inflexibility often observed in AN. Notably, atypical antipsychotics have been
studied more so because of their increased tolerability vs first-generation medications. The most studied atypical antipsychotic has been olanzapine,
due to its noted side effect of weight gain, in other indications such as psychotic disorders. Much of the research on olanzapine use in AN has
focused primarily on adults. The following is a review of the available literature pertaining to children and adolescents and olanzapine adjunctive
treatment. Method(s): EBSCOhost and PubMed were queried using the following terms: \"olanzapine + anorexia nervosa + child adolescent.\" Filters were
set for results from 2015 to 2020 and full articles. Articles were excluded if the topic of the article was not treatment of AN, and if the article
pertained to treatment of adults or a mixed sample of children/adolescents and adults. Meta-analyses and review articles were excluded. From
EBSCOhost, no relevant articles were obtained from 99 results. From PubMed, 2 articles were included. On review, 1 article was excluded because it
was a review article rather than new findings. Result(s): One nonrandomized open-label trial has been published regarding the use of olanzapine for
weight gain in children and adolescents with AN. In this study, patients in the intervention group receiving olanzapine had a statistically
significant elevation in the rate of weight gain in comparison to patients in the group not receiving olanzapine. Also observed was a 30% rate of
discontinuation of olanzapine due to side effects but not adverse events. Conclusion(s): There is only 1 available study examining the utilization of
olanzapine in a population exclusively of children and adolescents with AN. Because treatment of AN is challenging, it is important to understand the
available treatment options, their risks, and benefits. Further characterizing reasons for medication discontinuation is also vital to understanding
the viability of treatment options. This is particularly salient in a medication like olanzapine, for which the risk profile includes metabolic
effects such as insulin resistance and hyperlipidemia in adult patients. AXN, APS Copyright © 2020
Journal of the American Academy of Child and Adolescent Psychiatry, 59 (10
Supplement) : S185-S186
- Year: 2020
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Porras-Garcia, B., Serrano-Troncoso, E., Carulla-Roig, M., Soto-Usera, P., Ferrer-Garcia, M., Fernandez-Del-Castillo-Olivares, L., Figueras-Puigderrajols, N., Santos-Carrasco, I. M., Borszewski,
B., Diaz-Marsa, M., Gutierrez-Maldonado, J.,
Based on the preliminary findings of a randomized clinical trial
with patients with Anorexia Nervosa (AN), this study aims to provide initial evidence of the usefulness of a Virtual Reality body exposure therapy.
Method(s): 17 AN patients (9 in the experimental group, 8 in the control group) participated in the study. Fear of gaining weight (FGW), body
anxiety, drive for thinness, body image disturbances (BID), Body Mass Index (BMI) and body-related attention were assessed before and after the
intervention. Additionally, the experimental group underwent five sessions of VR body exposure therapy within the standard course of CBT, while
control patients received the usual CBT. Result(s): After the intervention, there were clear reductions in ED symptoms in both groups. The reduction
was especially marked in the experimental group. Finally, notable changes were recorded in dysfunctional body-related attention and BMI in the
experimental group, but not in controls. Conclusion(s): To the best of our knowledge, this is the first study to focus on treating FGW, body-related
concerns and body-related attention in AN using a VR-embodiment based paradigm. To pursue the analysis further, and to assess the effectiveness of
this new VR software, larger controlled clinical trials should now be conducted. Copyright © 2020, Interactive Media Institute. All rights
reserved.
Annual Review of CyberTherapy and Telemedicine, 18 : 223-
227
- Year: 2020
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Technology, interventions delivered using technology (e.g. online, SMS)
Melbye, S., Kessing, L. V., Bardram, J. E., Faurholt-Jepsen, M.
Background: Psychiatric
disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and
effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and
potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat
children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning
smartphone-based monitoring and treatment in this population has been published. Objective(s): This systematic review aims at describing the
following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment
delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies. Method(s): We conducted a systematic literature
search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a
smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were
diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had
participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance
with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically
assessed. Result(s): A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion.
These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and
suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants' adherence to self-
monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for
self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the
effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials,
the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at
high risk of bias in several areas. Conclusion(s): Smartphones hold great potential as a modern, widely available technology platform to help
diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies
regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses. Copyright © Sigurd Melbye, Lars Vedel
Kessing, Jakob Eyvind Bardram, Maria Faurholt-Jepsen. Originally published in JMIR Mental Health (http://mental.jmir.org), 29.10.2020. This is an
open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is
properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and
license information must be included.
JMIR Mental
Health, 7(10) :
- Year: 2020
- Problem: Anorexia Nervosa, Psychosis Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Hasselbalch, K. C., Lanng, K. R., Birkeland, M., Sjogren, M.
RATIONALE: The
psychopathology of anorexia nervosa (AN) includes altered social cognition and information processing of fear and anxiety. Oxytocin, a
neuromodulating hormone, may influence these functions and could be valuable for the treatment of AN.\rOBJECTIVE: The current study aimed at
reviewing the effect of intranasal oxytocin (IN-OT) on attentional bias (AB) and emotion recognition (ER) in AN.\rMETHODS: A systematic literature
review was done for free-text and the MeSH-terms: anorexia nervosa, feeding and eating disorders, and oxytocin. Six publications, reporting from 4
unique clinical trials, were included in this review. A meta-analysis was conducted to examine the effects of IN-OT on AB towards food images and ER
on healthy controls (HC) and patients with AN.\rRESULTS: Overall, IN-OT did not influence AB towards food images (effect size = 0.20 [- 0.16, 0.57],
p = 0.28) and had no effect on ER (effect size = - 0.01 [- 0.27, 0.26], p = 0.97) in patients with AN and healthy control (HC) subjects collectively.
Assessing HC and AN separately in subgroup analyses did not show any significant effect on AB and ER in neither of the subgroups. All tests were done
between 15 and 55 min post-administration of IN-OT, while peak concentration in the cerebrospinal fluid has been determined to be at 75 min.
\rCONCLUSION: The current level of evidence is moderate showing no effect of IN-OT on AB or ER in AN. However, brain exposure may not have been
sufficient which future studies with IN-OT need to ensure by considering dose and dose-to-task interval.
Psychopharmacology, 237(10) : 2891-
2903
- Year: 2020
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Datta, Nandini, Matheson,
Brittany E., Le-Grange, Daniel, Brandt,
Harry A., Woodside, Blake, Halmi, Katherine A., Wilfley, Denise E., Lock, James D.
Background: This study explores the impact of weight gain during medical stabilization\rhospitalization on
weight outcomes between three outpatient treatments for adolescent\ranorexia nervosa (AN): Adolescent Focused Therapy (AFT), Systemic Family Therapy
\r(SyFT), and Family Based Treatment (FBT).\rMethods: A secondary analysis of weight gain data (N = 215) of adolescents (12 - 18\ryears) meeting
DSM-IV criteria for AN (exclusive of amenorrhea criteria) who participated\rin two randomized clinical trials (RCTs) was conducted. Main outcomes
examined were\rchanges in weight restoration (
Frontiers in Psychiatry Vol 11 2020, ArtID
609675, 11 :
- Year: 2020
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Biney, H., Astbury, S., Haines, A., Grant,
J., Malone, N., Hutt, M., Matthews, R., Morgan, J. F., White, S., Lacey, J. H.
Purpose: To determine the potential effectiveness of a novel 10-week manualised Practical Body Image therapy (PBI) with mirror exposure
(ME), when used as an adjuvant to an intensive treatment package (TAU) in adolescent inpatients with Anorexia Nervosa (AN). To evaluate the
effectiveness of ME in an adolescent population. Method(s): Using a randomised control design, 40 girls aged 11-17 years with AN were assigned to PBI
with TAU (n = 20) and TAU alone (n = 20). Both groups completed self-report measures of body image at week 1 and week 10 of the study to measure the
potential effectiveness of PBI. The PBI group completed measures at week 7 to evaluate the ME component. Result(s): 31 participants completed the
study; 16 TAU, 15 PBI. PBI participants had greater improvement in all outcomes than TAU participants. Medium effect sizes were seen for self-
reported weight concern, body image avoidance in terms of clothing and body image anxiety. ME produced effect sizes in self-reported body image
avoidance in terms of clothing and grooming that were greater than 0.40, n = 14. Conclusion(s): The findings demonstrate that PBI supports an
intensive inpatient treatment package and addresses elements of negative body image. PBI was beneficial for addressing body image dissatisfaction
with improvements in weight concerns, body image avoidance and physical appearance trait anxiety following the ME component. The magnitude of the
effect sizes is comparable to previous studies. Positive qualitative feedback indicated the intervention was acceptable to users. PBI is a promising
new adjuvant treatment for AN. EMB Rating: Level I: randomized controlled trial. Copyright © 2020, The Author(s).
Eating and Weight Disorders., :
- Year: 2020
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Murray, S. B., Quintana,
D. S., Loeb, K. L., Griffiths, S., LeGrange, D.
BACKGROUND: To determine the impact of specialized treatments, relative to comparator treatments, upon the weight and psychological
symptoms of anorexia nervosa (AN) at end-of-treatment (EOT) and follow-up. METHOD(S): Randomized controlled trials (RCTs) between January 1980 and
December 2017 that reported the effects of at least two treatments on AN were screened. Weight and psychological symptoms were analyzed separately
for each study. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and studies were assessed using
the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria and Cochrane risk of bias tool. RESULT(S): We identified 35
eligible RCTs, comprising data from 2524 patients. Meta-analyses revealed a significant treatment effect on weight outcomes at EOT [g = 0.16, 95% CI
(0.05-0.28), p = 0.006], but not at follow-up [g = 0.11, 95% CI (-0.04 to 0.27), p = 0.15]. There was no significant treatment effect on
psychological outcomes at either EOT [g = -0.03, 95% CI (-0.14 to 0.08), p = 0.63], or follow-up [g = -0.001, 95% CI (-0.11 to 0.11), p = 0.98].
There was no strong evidence of publication bias or significant moderator effects for illness duration, mean age, year of publication, comparator
group category, or risk of bias (all p values > 0.05). CONCLUSION(S): Current specialized treatments are more adept than comparator interventions at
imparting change in weight-based AN symptoms at EOT, but not at follow-up. Specialized treatments confer no advantage over comparator interventions
in terms of psychological symptoms. Future precision treatment efforts require a specific focus on the psychological symptoms of AN.
Psychological Medicine, 49(4) : 535-544
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any)
Albano, G, Hodsoll, J, Kan, C, Lo-Coco,
G, Cardi, V.
The eating disorder clinical and scientific
community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature
on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of
studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index
(BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in
seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were
delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or
clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment
assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may
facilitate patients' treatment engagement and also improve carers' wellbeing.
International review of psychiatry (Abingdon, England), : 1-
15
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Self-help