Disorders - Anorexia Nervosa
Rizzo, S. M., Douglas, J. W., Lawrence, J. C.
Weight restoration is an important first step in
treating patients with anorexia nervosa (AN), because it is essential for medical stabilization and reversal of long-term complications. Tube feeding
may help facilitate weight restoration, but its role in treatment remains unclear. This study aimed to review the literature describing the efficacy,
safety, tolerance, and long-term effects of nasogastric (NG) refeeding for patients with AN. Four electronic databases were systematically searched
through May 2018. Boolean search terms included \"anorexia nervosa,\" \"refeeding,\" and \"nasogastric tube feeding.\" Ten studies were eligible for
inclusion: 8 retrospective chart reviews, 1 prospective cohort, and 1 randomized controlled trial. Nine of the studies were performed in-hospital. In
8 studies, NG nutrition resulted in an average rate of weight gain exceeding 1 kg/wk. In 4 of 5 studies including an oral-only control group, mean
weekly weight gain and caloric intake were significantly higher in tube-fed patients. Six studies provided prophylactic phosphate supplementation,
all with <1% occurrence rate of refeeding hypophosphatemia. Seven studies reported on other physiological disturbances, 6 evaluated medical and
gastrointestinal side effects, 3 considered psychological outcomes, and 4 assessed patients postdischarge. Results indicated that NG feeding was not
associated with an increased risk for adverse outcomes. Overall, in these studies, NG nutrition was considered safe and well tolerated, and
effectively increased caloric intake and rate of weight gain in patients with AN. However, results are limited by weaknesses in study designs, and
more rigorous methods are needed for development of evidence-based, standardized refeeding protocols. Copyright © 2018 American Society for
Parenteral and Enteral Nutrition
Nutrition in
Clinical Practice, :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Zeeck, A., Herpertz-Dahlmann,
B., Friederich, H. C., Brockmeyer,
T., Resmark, G., Hagenah, U., Ehrlich, S., Cuntz, U., Zipfel, S., Hartmann, A.
Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment
approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare
treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults). Methods:The data bases PubMed,
Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for
data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and
exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a
comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included.
Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC
analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual
psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient
treatment. Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and
adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response.
Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient
assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment
strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge. Copyright © 2018 Zeeck,
Herpertz-Dahlmann, Friederich, Brockmeyer, Resmark, Hagenah, Ehrlich, Cuntz, Zipfel and Hartmann.
Frontiers in Psychiatry, 9 (MAY) (no
pagination)(158) :
- Year: 2018
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Psychodynamic/Psychoanalysis, Other service delivery and improvement
interventions
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)
Manos, B. E., Bravender, T. D., Harrison, T. M., Lange, H. L. H., Cottrill, C. B., Abdel-Rasoul, M., Bonny, A. E.
Objective: To evaluate the effectiveness and tolerability of omega-3 polyunsaturated fatty acid (PUFA)
supplementation for treatment of trait anxiety among adolescent females with restrictive anorexia nervosa (AN). Method(s): A pilot double-blind,
placebo-controlled randomized trial of adolescent females with AN (N = 24) entering Partial Hospitalization Program (PHP) from January 2015 to
February 2016. Participants were randomized to four daily PUFA (2,120 mg eicosapentaenoic acid/600 mg docosohexaenoic acid) or placebo capsules for
12 weeks. A 9-item questionnaire of side effect frequency assessed medication tolerability. The Beck Anxiety Inventory-Trait measured anxiety at
baseline, 6, and 12 weeks. Linear mixed models evaluated associations between randomization group and study outcomes. Twenty-two and 18 participants
completed 6 and 12 weeks of data collection, respectively. Result(s): Medication side effect scores were low and were not significantly different
between randomization groups at Week 6 (p =.20) or 12 (p =.41). Mean trait anxiety score significantly (p <.01) decreased from baseline to 12 weeks
in both groups, and the rate of change over the course of time did not differ between omega-3 PUFA and placebo groups (p =.55). Conclusion(s):
Omega-3 PUFA supplementation was well tolerated in adolescent females with AN. Although power to detect differences was limited, we found no evidence
that omega-3 PUFA benefited anxiety beyond nutritional restoration. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 51(12) : 1367-
1372
- Year: 2018
- Problem: Anxiety Disorders (any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Manos, B. E., Bravender, T. D., Harrison, T. M., Lange,
H. L. H., Cottrill, C. B., Abdel-Rasoul, M., Bonny, A. E.
Objective: To evaluate the effectiveness and tolerability of omega-3 polyunsaturated fatty acid (PUFA)
supplementation for treatment of trait anxiety among adolescent females with restrictive anorexia nervosa (AN). Method(s): A pilot double-blind,
placebo-controlled randomized trial of adolescent females with AN (N = 24) entering Partial Hospitalization Program (PHP) from January 2015 to
February 2016. Participants were randomized to four daily PUFA (2,120 mg eicosapentaenoic acid/600 mg docosohexaenoic acid) or placebo capsules for
12 weeks. A 9-item questionnaire of side effect frequency assessed medication tolerability. The Beck Anxiety Inventory-Trait measured anxiety at
baseline, 6, and 12 weeks. Linear mixed models evaluated associations between randomization group and study outcomes. Twenty-two and 18 participants
completed 6 and 12 weeks of data collection, respectively. Result(s): Medication side effect scores were low and were not significantly different
between randomization groups at Week 6 (p =.20) or 12 (p =.41). Mean trait anxiety score significantly (p <.01) decreased from baseline to 12 weeks
in both groups, and the rate of change over the course of time did not differ between omega-3 PUFA and placebo groups (p =.55). Conclusion(s):
Omega-3 PUFA supplementation was well tolerated in adolescent females with AN. Although power to detect differences was limited, we found no evidence
that omega-3 PUFA benefited anxiety beyond nutritional restoration. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 51(12) : 1367-
1372
- Year: 2018
- Problem: Anxiety Disorders (any), Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Boerhout, C., Swart, M., Voskamp, M., Troquete, N. A., van-Busschbach, J. T., Hoek, H. W.
Objective: The objective is to evaluate a
body and movement-oriented intervention on aggression regulation, specifically aimed towards reducing anger internalization in patients with an
eating disorder. Method: Patients were randomized to treatment-as-usual (TAU) plus the intervention (n = 38) or to TAU only (n = 32). The
intervention was delivered by a psychomotor therapist. TAU consisted of multidisciplinary day treatment (3-5 days per week during 3-9 months). Anger
coping (Self-Expression and Control Scale) and eating pathology (Eating Disorder Examination-Self-report Questionnaire) were measured at baseline and
follow-up. Differences between pre-intervention and post-intervention scores were tested by using repeated measures ANOVA. Results: The intervention
group showed a significantly larger decrease of anger internalization than the control group (eta2 = 0.16, p = 0.001). Both groups showed a
significant reduction in eating pathology, but differences between groups were not significant. Discussion: A body and movement-oriented therapy
seems a viable add-on for treating anger internalization in patients with an eating disorder. (PsycINFO Database Record (c) 2017 APA, all rights
reserved)
European Eating Disorders Review, 25(1) : 52-
59
- Year: 2017
- Problem: Anorexia Nervosa, Bulimia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Linardon, J., Wade, T. D., de-la-Piedad Garcia, X., Brennan, L.
OBJECTIVE: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders.\rMETHOD:
Randomized controlled trials of CBT were searched. Seventy-nine trials were included.\rRESULTS: Therapist-led CBT was more efficacious than inactive
(wait-lists) and active (any psychotherapy) comparisons in individuals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most
efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for
bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological
interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at
posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in
greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than
behavior therapy or nonspecific supportive therapies.\rCONCLUSIONS: CBT is efficacious for eating disorders. Although CBT was equally efficacious to
certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically,
offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are hampered by the fact that
many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record
Journal of Consulting & Clinical Psychology, 85(11) : 1080-
1094
- Year: 2017
- Problem: Anorexia Nervosa, Binge Eating Disorders, Bulimia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Byrne, S., Wade, T., Hay, P., Touyz, S., Fairburn, C., Treasure, J., Schmidt, U., McIntosh, V., Allen, K., Fursland,
A., Crosby, R.
Background: There is a lack of evidence pointing to the
efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for
AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy.
Method: A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month
follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty individuals meeting diagnostic
criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25-40 sessions over a 10-month period.
Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and
psychosocial impairment. Results: Treatment was completed by 60% of participants and 52.5% of the total sample completed 12-month follow-up.
Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes; all resulted in
clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained
over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission
(mean = 28.3%) at 12-month follow-up. Conclusion: The findings add to the evidence base for these three psychological treatments for adults with AN,
but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. (PsycINFO Database Record (c) 2018 APA,
all rights reserved)
Psychological Medicine, 47(16) : 2823-2833
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Supportive
therapy, Other Psychological Interventions, Case management