Disorders - Anorexia Nervosa
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
van-den-Berg, E., Houtzager, L., de-Vos, J., Daemen, I., Katsaragaki, G., Karyotaki, E., Cuijpers, P., Dekker, J.
Objective: This meta-analysis examines the efficacy of recently developed psychological treatments for anorexia nervosa, compared with
control condition. Outcome criteria are weight gain, eating disorder pathology, and quality of life. Method(s): Twelve thousand nine hundred ninety-
seven abstracts, published between 1980 and 2017, were retrieved. End-of-treatment data from 1,279 participants, from 15 of 17 eligible studies, were
used to calculate pooled-effect sizes (Hedges' g) for outcome using random-effects model. Subgroup analyses were used to explore the influence of
various patient and study characteristics. Result(s): No significant differences between psychological treatment and controls were found on weight
gain, g = 0.07, 95% CI [-0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [-0.10, 0.21], and quality of life, g = -0.11, 95% CI [-0.36,
0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High-
quality studies and studies with reported therapist training had larger effects on weight gain and quality of life compared with low-quality studies
and studies without reported training. Conclusion(s): Despite progress in the development of specialized treatments, the efficacy of psychological
treatment over an active control condition could not be established. Outcomes, however, are obscured by low-quality and heterogeneous studies.
Copyright © 2019 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 27(4) : 331-
351
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Fisher, C. A., Skocic, S., Rutherford, K. A., Hetrick, S. E.
Anorexia nervosa (AN) is characterised by
a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual
from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of
relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in
treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to
the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that
involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. Objectives To
evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. Search methods We searched the
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches
directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the
World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the
reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to
April 2016. Selection criteria Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of
family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia
nervosa. Data collection and analysis Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-
analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the
mean difference to summarise continuous measures. Main results We included 25 trials in this version of the review (13 from the original 2010 review
and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and
one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of
trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective
reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with
44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two
studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post
intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from
only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to
determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1
study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is
difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67;
participants = 252; studies = 5; I2 = 37%) and at long-ter follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1
of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact
on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult
studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other
psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants =
210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient
evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating
disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. Authors' conclusions
There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the
short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is
insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational
interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this
finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different
age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to
determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted
trials. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, 2019 (5) (no
pagination)(CD004780.) :
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
van-den-Berg, E., Houtzager, L., de-Vos, J., Daemen, I., Katsaragaki, G., Karyotaki, E., Cuijpers, P., Dekker, J.
Objective: This meta-analysis examines the efficacy of recently developed psychological treatments for anorexia nervosa, compared with
control condition. Outcome criteria are weight gain, eating disorder pathology, and quality of life. Method(s): Twelve thousand nine hundred ninety-
seven abstracts, published between 1980 and 2017, were retrieved. End-of-treatment data from 1,279 participants, from 15 of 17 eligible studies, were
used to calculate pooled-effect sizes (Hedges' g) for outcome using random-effects model. Subgroup analyses were used to explore the influence of
various patient and study characteristics. Result(s): No significant differences between psychological treatment and controls were found on weight
gain, g = 0.07, 95% CI [-0.09, 0.23], eating disorder pathology, g = 0.06, 95% CI [-0.10, 0.21], and quality of life, g = -0.11, 95% CI [-0.36,
0.15]. Studies including only patients over 18 years of age were more effective on weight gain than studies including adolescents as well. High-
quality studies and studies with reported therapist training had larger effects on weight gain and quality of life compared with low-quality studies
and studies without reported training. Conclusion(s): Despite progress in the development of specialized treatments, the efficacy of psychological
treatment over an active control condition could not be established. Outcomes, however, are obscured by low-quality and heterogeneous studies.
Copyright © 2019 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 27(4) : 331-
351
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Fisher, C. A., Skocic, S., Rutherford, K.
A., Hetrick, S. E.
Anorexia nervosa (AN) is characterised by
a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual
from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of
relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in
treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to
the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that
involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. Objectives To
evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. Search methods We searched the
Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches
directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the
World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the
reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to
April 2016. Selection criteria Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of
family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia
nervosa. Data collection and analysis Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-
analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the
mean difference to summarise continuous measures. Main results We included 25 trials in this version of the review (13 from the original 2010 review
and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and
one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of
trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective
reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with
44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two
studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post
intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from
only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to
determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1
study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is
difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67;
participants = 252; studies = 5; I2 = 37%) and at long-ter follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1
of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact
on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult
studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other
psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants =
210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient
evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating
disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. Authors' conclusions
There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the
short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is
insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational
interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this
finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different
age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to
determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted
trials. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, 2019 (5) (no
pagination)(CD004780.) :
- Year: 2019
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Jacobi, C., Hutter, K., Volker, U., Mobius, K., Richter,
R., Trockel, M., Jones-Bell, M., Lock, J., Taylor, C. B.
BACKGROUND: Web-based preventive interventions can reduce risk and incidence of bulimia and binge eating disorders among young high-risk
women. However, their specific effects on core symptoms of anorexia nervosa (AN) are rather weak. OBJECTIVE(S): The primary objective of this study
was to evaluate the efficacy of an indicated, parent-based, Web-based preventive program Eltern als Therapeuten (E@T) in reducing risk factors and
symptoms of AN. METHOD(S): Girls aged between 11 and 17 years were screened by selected risk factors and early symptoms of AN. At-risk families were
then randomized to E@T or an assessment-only control condition. Assessments took place at pre- and postintervention (6 weeks later) and at 6- and 12
-month follow-up (FU). RESULT(S): A total of 12,377 screening questionnaires were handed out in 86 German schools, and 3941 including consent
returned. Overall, 477 (447/3941, 12.10%) girls were identified as at risk for AN and 256 of those could be contacted. In all, 66 families (66/256,
25.8% of those contacted) were randomized to the E@T or a wait-list control condition, 43 (43/66, 65%) participated in postassessments, and 27
(27/66, 41%) in 12-month FUs. Due to low participation and high dropout rates of parents, recruitment was terminated prematurely. At 12-month FU,
girls' expected body weight (EBW) percentage was significantly greater for intervention participants compared with control participants (group by
time interaction beta=21.0 [CI 5.81 to 36.13], P=.007; group by time squared interaction beta=-15.5 [CI -26.6 to -4.49], P=.007; estimated Cohen
d=0.42]. No other significant effects were found on risk factors and attitudes of disturbed eating. CONCLUSION(S): Despite a significant increase in
girls' EBW percentage, parental participation and adherence to the intervention were low. Overall, parent-based, indicated prevention for children
at risk for AN does not seem very promising, although it might be useful for parents who engage in the intervention. TRIAL REGISTRATION:
International Standard Randomized Controlled Trial Number (ISRCTN): 18614564; http://www.isrctn.com/ISRCTN18614564 (Archived by WebCite at
http://www.webcitation.org/74FTV1EpF). Copyright ©Corinna Jacobi, Kristian Hutter, Ulrike Volker, Katharina Mobius, Robert Richter, Mickey Trockel,
Megan Jones Bell, James Lock, C Barr Taylor. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.12.2018.
Journal of Medical Internet
Research, 20(12) : e296
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Beykloo, M.Y., Naser, A., Nicholls, D., Simic, M., Brauer, R., Wong, I.
Background/Introduction: Anorexia Nervosa
(AN) is a mental disorder that onsets in adolescents. Treatment of anorexia nervosa is mainly carried out through a multidisciplinary approach, with
psychological interventions given as first line treatment. However, psychotropic medications are sometimes prescribed if initial psychotherapy does
not provide an optimal treatment response [1, 2]. Objective/Aim: This systematic review aims to review the existing literature on the safety and
efficacy of psychotropic medications treatment in adolescents with anorexia nervosa. Method(s): The PubMed, EMBASE, PsychINFO and Cochrane Review
databases were searched for relevant studies published up to October 2017 investigating psychotropic medications and their safety and efficacy in
adolescents with AN. Randomised controlled trials (RCTs) and observational studies were included with no restrictions on study design or psychotropic
medication therapeutic class. The primary outcome was defined as weight change as a measurement of drug efficacy, while secondary outcomes included
safety of psychotropic medications with regards to adverse events, side effects, safety measurements and death. Result(s): A total of 824 citations
were identified of which 10 studies were included in our narrative review. These comprised of three RCTs and seven observational studies, covering a
total of 1032 individuals ranging from 10 to 21 years of age. All studies did not find a significant association between the use of psychotropic
medications for adolescents with AN and weight change. 70% of the studies (7 out of 10) confirmed safety issues among users of psychotropic
medications, however the safety outcomes varied even between medications from the same therapeutic class, thus prevented us from aggregating the
results. Conclusion(s): The findings of this review fails to provide strong evidence for the efficacy of the use of psychotropic medications
treatment in adolescents with anorexia nervosa. These preliminary results demonstrate a need to characterise the behaviours that lead clinicians to
prescribe, and to explore the effects of medication on those specific behaviours, in order to establish the therapeutic efficacy and safety of
psychotropics in the treatment of adolescents with anorexia nervosa.
Drug Safety, 41 (11) : 1136
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Wallis, A., Miskovic-Wheatley,
J., Madden, S., Alford, C., Rhodes, P., Touyz, S.
OBJECTIVE: Our aim was to investigate the benefit of ongoing family-based
treatment (FBT) sessions for adolescent anorexia nervosa if remission criteria were not met at session 20. METHOD(S): Participants were 69 medically
unstable adolescents with Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) anorexia nervosa from a randomized controlled trial
investigating length of hospital admission prior to outpatient FBT. Participants were divided post hoc into those meeting remission criteria at
session 20 ( n=16), those that had not remitted but continued with FBT ( n=39) and those who ceased FBT undertaking alternative treatments ( n=14).
Outcome was assessed as remission and hospital readmission days at 12months after FBT session 20. RESULT(S): There were no differences between groups
at baseline. There was a significant difference in the use of hospital admission days with those in the Alternate Treatment Group who did not
continue with FBT using 71.93days compared to those in Additional FBT Group with only 12.51days ( F(2, 66)=13.239, p<.01). At 12months after FBT
session 20, the Additional FBT Group had a 28.2% increase in remission rate, significantly higher than those in the Alternate Treatment Group (chi2
(2)=17.68, p <.001). DISCUSSION: Continuing FBT after session 20 if remission is not achieved can significantly reduce hospital readmission days and
improve remission rates.
Clinical child psychology and
psychiatry, 23(4) : 592-600
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Brockmeyer, T., Friederich, H.C., Schmidt, U.
BACKGROUND: Anorexia nervosa (AN) is a disabling, deadly and costly mental
disorder. Until recently, treatment recommendations were based on expert opinion and limited evidence. The aim of this systematic review is to
synthesise recent evidence on established and emerging AN treatments and to forecast trends for future developments. METHOD(S): We systematically
review trials of established treatments and associated process outcome studies from the last 5 years, published since a previous review in this
journal. 'Established' treatments were those that are widely used in AN, recommended by guidelines and/or have been tested in at least one large
randomised controlled trial. Secondly, we summarise emerging treatments for AN, i.e. those that have only been (or are currently being) tested in
proof-of concept, feasibility or pilot trials. RESULT(S): We identified 19 published trials of established treatments (15 of high or moderate
quality), mostly assessing psychological therapies (n = 17). We also found 11 published trials of emerging treatments, and a total of 34 registered,
as yet unpublished trials. Promising emerging treatments include cognitive remediation therapy, exposure therapy and non-invasive neuromodulation.
CONCLUSION(S): Evidence generation on the treatment of AN has dramatically accelerated, with our understanding of the role of family-based approaches
for adolescents more nuanced and a range of psychological approaches available for the treatment of adults. Evidence on emerging treatments and from
forthcoming trials suggests that there is a shift towards more targeted brain-based interventions. Future studies need to focus on elucidating
mechanisms of action of treatments and what works best for whom.
Psychological Medicine, 48(8) : 1228-1256
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder), Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any), Family therapy
Ye, C., Hu, Z., Safani, D., Lu, W., Zhang, F., Reynolds, J.
Objectives: Anorexia nervosa (AN) has the highest mortality
rate of all mental illnesses, and weight restoration is a primary medical goal for treatment of AN. An atypical antipsychotic drug, olanzapine, has
shown some promise as a possible adjunctive treatment option for patients with AN. The aim of this meta-analysis was to assess the utility of
olanzapine for improvement of weight restoration. Method(s): A web-based literature search of all published and unpublished RCTs investigating the
effectiveness of olanzapine pharmacotherapy for AN published in English, Spanish, and Chinese from inception to January 2018 was performed. The Jadad
score was used to evaluate the quality of the articles. The primary outcome was body weight gain measured by mean change in BMI from study baseline
to endpoint. Result(s): Six RCT studies (5 in English, 1 in Chinese) consisting of a total of 206 patients with AN were included in this meta-
analysis. No publication bias was found in the meta-analysis, and the sensitivity analysis indicated that the results were stable. The mean study
duration was 28 weeks (range 8a\"48 weeks). The dose of olanzapine ranged from 5 to 20 mg per day. The effect on BMI was significantly different
between olanzapine and placebo/usual care in all articles pooled together [weighted mean difference (WMD) = 0.53; 95% CI 0.07a\"1.00; Z = 2.24; p =
0.025]. Subgroup analyses revealed that the increase in BMI was significantly different in patients treated with a higher dose of olanzapine (a10 mg
per day) (WMD = 1.38; 95% CI 0.43a\"2.33; Z = 2.85; p = 0.004). Conclusion(s): We found significant efficacy for pharmacotherapy with olanzapine in
AN. Olanzapine might be a promising treatment option for patients with AN. AXN, RCT, PPC Copyright © 2018
Journal of the American Academy of Child and Adolescent
Psychiatry, 57 (10 Supplement) : S204
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation)
Adamson, J., Leppanen, J., Murin, M., Tchanturia, K.
Objective: The aim of this study was to
examine the effectiveness of CREST interventions in individual and group formats for adult anorexia nervosa. Furthermore, this study also aims to
analyse whether patients with high levels of autistic symptoms respond differently. Methods: Participants' self-report measures were taken before
and after individual and group interventions (N = 66 and N = 62, respectively). Mixed effects analysis was used to analyse overall response to both
formats and assess interaction with autism symptoms. Results: Significant improvements were observed for patients' alexithymia in individual format,
and motivation increased for participants in both interventions. Significant interactions were observed between alexithymia, social anhedonia, and
autism symptoms in individual format and alexithymia in group format. No interactions between autism and time were observed for either format.
Conclusions: CREST in both formats offers participants improvements in social-emotional and motivational domains. Patients with high levels of autism
symptoms also score high on both social anhedonia and alexithymia measures, but this does not affect their response to treatment. Copyright © 2018
John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 26(4) : 367-
375
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy, Skills training