Disorders - Anorexia Nervosa
Lock, J.
Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of Clinical Child & Adolescent Psychology, 44(5) : 707-721
- Year: 2015
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa, Eating disorders not specified
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Dialectical behavioural therapy (DBT)
, Family therapy, Supportive therapy
Pirog-Balcerzak, A., Bazynska, K., Bragoszewska, J., Remberk, B., Popek, L., Rybakowski, F.
Introduction: Anorexia nervosa (AN) is a severe psychiatric disorder mainly of young females, which may lead to significant morbidity and mortality. Prolonged fasting presented by AN patients may lead to nutritional deficiencies including reduced concentration of polyunsaturated fatty acids omega-3 (PUFA) in the cell membranes [1]. PUFA are major component of phospholipids building the cell and intracellular membranes of neurons. They are responsible for many regulatory processes in the central nervous system comprising cognitive functions and mood stability. Preliminary studies showed the efficacy of EPA in adolescent depression and other developmental neuropsychiatric disorders. One study suggested the efficacy of EPA supplementation in the treatment of patients with anorexia nervosa [2]. Purpose of the study: To determine if polyunsaturated fatty acids omega - 3 are effective as an add-on therapy in inpatient adolescents with anorexia nervosa. Methods: Sixty-one teenage girls (12-19 years) diagnosed with anorexia nervosa according to International Classification of Diseases Tenth Revision (ICD-10) were recruited in the period from September 2012 till October 2014. Subjects were hospitalized in Child and Adolescent Psychiatry Department, Institute of Psychiatry and Neurology, Warsaw. Mean age at the index admission was 16.2±1.6. Demographic data, history of illness, laboratory tests, weight, height, BMI and psychometric tests (Clinical Global Impression-CGI, Patient Global Impression - PGI, Eating Attitude Test-26 - EAT-26) were obtained at baseline visit. During the admission patients underwent therapeutic and behavioral program and were fed with a calorie-rich diet. In the randomized, doubleblind manner subjects received active substance or placebo for 10 weeks. The active substance capsules contained 558 mg of eicosapentaenoic acid, 174 mg of docosahexaenoic acid and 60 mg of gamma linolenic acid, and placebo capsules contained olive oil. At the end of the study subjects were reexamined with the same evaluation measures. Normally and non-normally distributed variables were analyzed respectively with T-test and Mann-Whitney U test and categorical variables were analyzed with chi-square test. The groups were unblinded after analyzing statistics data. Results: Fifty three patients completed the 10 weeks trial. Both groups showed improvement in all evaluated parameters. There was a significantly better improvement in placebo vs. PUFA group in CGI score (1.72±1.1 vs. 1.28±1.27; p <0.05), and at statistical trend level in PGI score (1.4±1.6 vs. 0.6±1.7; p<0.07). Non-significantly better improvement in EAT-26 score was also observed in placebo vs. EPA group (16±15.5 vs. 14±17.7). Girls supplemented with PUFA showed non-significant increase in BMI (2.5±1.5 vs 2.2±1.4). Conclusion: In teenage girls with anorexia nervosa, supplementation with PUFA during inpatient treatment did not improve recovery. Unexpectedly, clinician-rated global improvement was better in placebo group. This finding may suggest some effect of EPA on emotional or cognitive processes sustaining AN symptoms.
European Neuropsychopharmacology, 25 : S646
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Fish oil (Omega-3 fatty acids)
, Omega 3 fatty acids (e.g. fish oil, flax oil)
Suarez-Pinilla, P., Pena-Perez, C., Arbaizar-Barrenechea, B., Crespo-Facorro, B., Del-Barrio, J. A. G., Treasure, J., Llorca-Diaz, J.
Background: Anorexia nervosa (AN) is a serious psychiatric disease. Choice of acute inpatient care for AN is driven by the severity of symptoms and the level of risk to the patient. Inpatient hospitalization of patients with AN typically includes a behavioral weight gain protocol that is designed to address the core features of the disorder: weight, appetite, and distorted thoughts and behavior. Some add-on treatments may also be included in the inpatient treatment model and may have potential benefits, including faster or greater weight gain; such treatments include psychotherapy, psychoeducation, pharmacological treatment, and nutritional replacement.; Objective: The goal of this study was to systematically review randomized clinical trials (RCTs) that have compared the efficacy of different forms of add-on treatment delivered during admission to a 24-hour hospital and to summarize the existing data regarding weight gain associated with such pharmacological, medical, and psychological interventions.; Methods: Systematic electronic and manual searches were conducted to identify published RCTs concerning inpatient treatment of AN. Weight gain was used as the main outcome variable.; Results: Overall, no significant increase in weight recovery was reported with atypical antipsychotics compared to placebo or therapy as usual. Only one study showed slight benefits in young patients during hospitalization (d=0.77; 95% confidence interval [CI] -0.09-1.64). No significant effects on weight recovery were found for antidepressants (d=-0.10; 95% CI=-0.63-0.42). In addition, none of the add-on psychotherapy techniques that were evaluated demonstrated superiority compared with control interventions in the inpatient setting. Cyclic enteral nutrition was studied in one RCT in which it demonstrated superiority compared to oral refeeding only (d=0.97; 95% CI=0.51-1.47). Other less common treatments such as bright light therapy and lithium carbonate were not found to produce additional significant weight improvement compared with placebo.; Conclusion: Most add-on treatments during the acute inpatient phase of AN treatment are not effective in increasing weight recovery. Long-term follow-up studies after the acute treatment phase are needed to make evidence-based recommendations.;
Journal of Psychiatric Practice, 21(1) : 49-59
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Schmidt, U., Magill, N., Renwick, B., Keyes, A., Kenyon, M., Dejong, H., Lose, A., Broadbent, H., Loomes, R., Yasin, H., Watson, C., Ghelani, S., Bonin, E., Serpell, L., Richards, L., Johnson-Sabine, E., Boughton, N., Whitehead, L., Beecham, J., Treasure, J., Landau, S.
Objective: Anorexia nervosa (AN) in adults has poor outcomes, and treatment evidence is limited. This study evaluated the efficacy and acceptability of a novel, targeted psychological therapy for AN (Maudsley Model of Anorexia Nervosa Treatment for Adults; MANTRA) compared with Specialist Supportive Clinical Management (SSCM). Method: One hundred forty-two outpatients with broadly defined AN (body mass index [BMI] < 18.5 kg/m2) were randomly allocated to receive 20 to 30 weekly sessions (depending on clinical severity) plus add-ons (4 follow-up sessions, optional sessions with dietician and with carers) of MANTRA (n = 72) or SSCM (n = 70). Assessments were administered blind to treatment condition at baseline, 6 months, and 12 months after randomization. The primary outcome was BMI at 12 months. Secondary outcomes included eating disorders symptomatology, other psychopathology, neuro-cognitive and social cognition, and acceptability. Additional service utilization was also assessed. Outcomes were analyzed using linear mixed models. Results: Both treatments resulted in significant improvements in BMI and reductions in eating disorders symptomatology, distress levels, and clinical impairment over time, with no statistically significant difference between groups at either 6 or 12 months. Improvements in neuro-cognitive and social-cognitive measures over time were less consistent. One SSCM patient died. Compared with SSCM, MANTRA patients rated their treatment as significantly more acceptable and credible at 12 months. There was no significant difference between groups in additional service consumption. Conclusions: Both treatments appear to have value as first-line outpatient interventions for patients with broadly defined AN. Longer term outcomes remain to be evaluated. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 83(4) : 796-807
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Family therapy, Case management
Hay, P. J., Claudino, A. M., Touyz, S., Abd-Elbaky, G.
Background: Anorexia nervosa is a disorder with high morbidity and significant mortality. It is most common in young adult women, in whom the incidence may be increasing. The focus of treatment has moved to an outpatient setting, and a number of differing psychological therapies are presently used in treatment. This is an update of a Cochrane review which was last published in 2008.; Objectives: To assess the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents treated in an outpatient setting.; Search Methods: We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised Register (CCDANCTR) (16 July 2014). This register includes relevant randomised controlled trials from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We screened reference lists of all included studies and sent letters to identified, notable researchers requesting information on unpublished or ongoing studies.; Selection Criteria: All randomised controlled trials of one or more individual outpatient psychological therapies for adults with anorexia nervosa, as defined by DSM-5 or similar international criteria.; Data Collection and Analysis: We selected a range of outcome variables, including physical state, severity of eating disorder attitudes and beliefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons used the mean or standardised mean difference (MD or SMD), and binary outcome comparisons used the risk ratio (RR). Two review authors (PH and AC or ST) extracted data independently.; Main Results: We identified 10 trials from the search, with a total of 599 anorexia nervosa participants, and included them in the review. Seven had been identified in the previous versions of this review and we now include three new trials. We now deem one previously identified ongoing trial to be ineligible, and six ongoing trials are new for this update. Two of the 10 trials included children. Trials tested diverse psychological therapies and comparability was poor. Risks of bias were mostly evident through lack of blinded outcome assessments (in 60% of studies) and incomplete data reporting (attrition bias).The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% confidence interval (CI) 0.51 to 0.97; 1 RCT, 40 participants; very low-quality evidence). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, 71 participants; very low-quality evidence), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU.Two trials found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91; 197 participants, low-quality evidence). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (35 participants). None of the trials identified any adverse effects. Insufficient power was problematic for the majority of trials.; Authors' Conclusions: There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.;
Cochrane Database of Systematic Reviews, (7) : CD003909
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Herpertz-Dahlmann, B., Krei, M., Buhren, K., Schwarte, R., Egberts, K., Wewetzer, C., Pfeiffer, E., Fleischhaker, C., Konrad, K., Schade-Brittinger, C., Timmesfeld, N., Dempfle, A.
Day patient treatment (DP) is superior to inpatient treatment (IP) in adolescent anorexia nervosa (AN): results of the 2.5 year follow-up of a multicenter RCT trial in 172 patients Introduction: Guidelines of several European countries and the US consider IP as the treatment of choice for moderately to severely ill adolescent patients with AN, but it is costly and relapse rates are high. DPis less expensive and may avoid relapse by easing the transition from hospital to home. Methods: Multicenter, randomized, open-label trial with 11-18 year old participants from six centers in Germany with first admission to hospital for AN. After 3 weeks of inpatient care patients were randomly assigned to either IP or DP with an identical treatment program in both settings.The primary outcome was the increase in BMI between admission and 12-month follow-up and between admission and 2.5 years follow-up. Results: 172 adolescent patients were randomized to either treatment arm; 161 (94 %) were followed up after 12 months, 143 (83 %) after 2.5 years. At the 12-month follow-up DP was not inferior to IP. At the 2.5 year follow-up DP was significantly superior to IP with regard to BMI and was followed by significantly less rehospitalisations. In addition DP was less costly than IP and psychosexual development, an important outcome predictor, was better in DP patients. Conclusions: After 1 year DP was not less effective than IP; after 2.5 years it was superior to DP for weight restoration and maintenance and number of rehospitalisations. Thus, in the longer term DP is a safe, less costly and probably more effective alternative to IP. Characteristics of patients, who are doing better in either DP or IP, are described.
European Child & Adolescent Psychiatry, 24(1) : S97
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
McElroy, S. L., Guerdjikova, A. I., Mori, N., Keck-Jr, P. E.
Psychopharmacologic treatment is playing a greater role in the management of patients with eating disorders. In this paper, we review randomized, placebo-controlled trials (RCTs) conducted in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other eating disorders over the past 3 years. Fluoxetine remains the only medication approved for an eating disorder, that being BN. RCTs of antipsychotics in AN have had mixed results; the only agent with some evidence of efficacy is olanzapine. One study suggests dronabinol may induce weight gain in AN. Preliminary studies suggest lack of efficacy of alprazolam, dehydroepiandrosterone, or physiologic estrogen replacement in AN; erythromycin in BN; and the opioid antagonist ALKS-33 in BED. In BED with obesity or overweight, bupropion may cause mild weight loss without seizures, and chromium may improve glucose regulation. Also in BED, three RCTs suggest the stimulant prodrug lisdexamfetamine may reduce binge eating episodes, and another RCT suggests intranasal naloxone may decrease time spent binge eating. There remains a disconnection between the size of eating disorders as a public health problem and the lack of pharmacotherapy research of these conditions.;
Current Psychiatry Reports, 17(5) : 35-35
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
, Other biological interventions
Mountford, V. A., Brown, A. Bamford, B., Saeidi, S., Morgan, J. F., Lacey, H.
Body image disturbance can be enduring and distressing to individuals with eating disorders and effective treatments remain limited. This pilot study evaluated a group-based treatment-BodyWise-developed for use in full and partial hospitalization with patients with anorexia nervosa at low weight. A partial crossover waitlist design was used. BodyWise (N = 50) versus treatment as usual (N = 40) were compared on standardized measures of body image disturbance. Results demonstrated significant improvement in the group compared to treatment as usual for the primary outcome measure (Eating Disorder Examination-Questionnaire Shape Concern subscale) and other manifestations of body image disturbance including body checking and body image quality of life. BodyWise appeared acceptable to participants, and was easy to deliver within the pragmatics of a busy eating disorder service. There is potential for its wider dissemination as a precursor to more active body image interventions. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
European Eating Disorders Review, 23(1) : 62-67
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Lock, J., Le-Grange, D., Agras, W., Fitzpatrick, K. K., Jo, B., Accurso, E., Forsberg, S., Anderson, K., Arnow, K., Stainer, M.
Objective: Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. Method: 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. Outcomes: There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (> 95% of expected mean BMI) by EOT at similar rates as those who had responded early. Conclusions: The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 73 : 90-95
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Other Psychological Interventions
Kim, Y-R., Eom, J-S., Yang, J-W., Kang, J., Treasure, J.
Background and Aim: Social difficulties and problems related to eating behaviour are common features of both anorexia nervosa (AN) and bulimia nervosa (BN). The aim of this study was to examine the impact of intranasal oxytocin on consummatory behaviour and emotional recognition in patients with AN and BN in comparison to healthy controls. Materials: A total of 102 women, including 35 patients with anorexia nervosa (AN), 34 patients with bulimia nervosa (BN), and 33 healthy university students of comparable age and intelligence, participated in a double-blind, single dose placebo-controlled cross-over study. A single dose of intranasal administration of oxytocin (40 IU) (or a placebo) was followed by an emotional recognition task and an apple juice drink. Food intake was then recorded for 24 hours post-test. Results: Oxytocin produced no significant change in appetite in the acute or 24 hours free living settings in healthy controls, whereas there was a decrease in calorie consumption over 24 hours in patients with BN. Oxytocin produced a small increase in emotion recognition sensitivity in healthy controls and in patients with BN, In patients with AN, oxytocin had no effect on emotion recognition sensitivity or on consummatory behaviour. Conclusions: The impact of oxytocin on appetite and social cognition varied between people with AN and BN. A single dose of intranasal oxytocin decreased caloric intake over 24 hours in people with BN. People with BN showed enhanced emotional sensitivity under oxytocin condition similar to healthy controls. Those effects of oxytocin were not found in patients with AN. Trial Registration: ClinicalTrials.gov KCT0000716. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
PLoS ONE, 10(9) : ArtID e0137514
- Year: 2015
- Problem: Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Levinson, C. A., Rodebaugh, T. L., Fewell, L., Kass, A. E., Riley, E. N., Stark, L. J., McCallum, K., Lenze, E. J.
Objective: Exposure therapy in anorexia nervosa has preliminarily been shown to be effective for increasing food intake. D-Cycloserine is a glutamatergic N-methyl-d-aspartate receptor agonist that has been shown to facilitate the benefits of exposure therapy for anxiety disorders by enhancing the emotional learning in the exposures; therefore, we examined D-cycloserine-facilitation of exposure therapy to increase body mass index (BMI) in patients with anorexia nervosa.; Method: Participants (N = 36) with anorexia nervosa (diagnosed via DSM-IV) were recruited from a partial hospitalization eating disorder clinic between February 2013 and November 2013. Participants were randomly assigned to receive exposure therapy plus D-cycloserine (n = 20) or placebo (n = 16). Participants completed psychoeducation and 4 sessions of exposure therapy, with medication (D-cycloserine vs placebo) given prior to the first 3 exposure sessions. They also completed a 1-month follow-up.; Results: As hypothesized, participants in the D-cycloserine group showed a significantly greater increase in BMI than those in the placebo group (Wilk Λ = 0.86, F3,32 = 2.20, P = .043, ηp(2) = 0.12). D-Cycloserine participants gained 3 pounds relative to 0.5 pounds in the placebo group. Both groups experienced significantly decreased anxiety over the course of therapy (Wilk Λ = 0.80, F3,32 = 3.32, P = .023, ηp(2) = 0.20).; Conclusions: This study preliminarily demonstrates that D-cycloserine facilitates exposure therapy for anorexia nervosa, leading to increased weight gain. A potential mechanism is that participants who receive D-cycloserine may generalize learning from within-session exposures to food intake during other similar meals, resulting in sustained increases in BMI. Further research is needed to confirm these findings and test the putative mechanism that generalized learning from exposure therapy can increase BMI and stabilize a healthy weight.; Trial Registration: ClinicalTrials.gov identifier: NCT01996644.; © Copyright 2015 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 76(6) : e787-e793
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Psychoeducation, D-cycloserine (DCS)
Herpertz-Dahlmann, Beate., Schwarte, Reinhild., Krei, Melanie., Egberts, Karin., Warnke, Andreas., Wewetzer, Christoph., Pfeiffer, Ernst., Fleischhaker, Christian., Scherag, Andre., Holtkamp, Kristian., Hagenah, Ulrich., Buhren, Katharina., Konrad, Kerstin., Schmidt, Ulrike., Schade-Brittinger, Carmen., Timmesfeld, Nina., Dempfle, Astrid.
Background: In-patient treatment (IP) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa, but it is costly, and the risks of relapse and readmissions are high. Day patient treatment (DP) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home. We investigated the safety and efficacy of DP after short inpatient care compared with continued IP.; Methods: For this multicentre, randomised, open-label, non-inferiority trial, we enrolled female patients (aged 11-18 years) with anorexia nervosa from six centres in Germany. Patients were eligible if they had a body-mass index (BMI) below the tenth percentile and it was their first admission to hospital for anorexia nervosa. We used a computer-generated randomisation sequence to randomly assign patients to continued IP or DP after 3 weeks of inpatient care (1:1; stratified for age and BMI at admission). The treatment programme and treatment intensity in both study groups were identical. The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness (non-inferiority margin of 0·75 kg/m(2)). Analysis was done by modified intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Number Register, number ISRCTN67783402, and the Deutsches Register Klinischer Studien, number DRKS00000101.; Findings: Between Feb 2, 2007, to April 27, 2010, we screened 660 patients for eligibility, 172 of whom we randomly allocated to treatment: 85 to IP and 87 to DP. DP was non-inferior to IP with respect to the primary outcome, BMI at the 12-month follow-up (mean difference 0·46 kg/m(2) in favour of DP (95% CI, -0·11 to 1·02; pnon-inferiority<0·0001). The number of treatment-related serious adverse events was similar in both study groups (eight in the IP group, seven in the DP group). Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation; one patient in the DP attempted suicide 3 months after she was discharged.; Interpretation: DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission. Thus, DP might be a safe and less costly alternative to IP. Our results justify the broad implementation of this approach.; Funding: German Ministry for Education and Research.; Copyright © 2014 Elsevier Ltd. All rights reserved.
Lancet, 383(9924) : 1222-1229
- Year: 2014
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions