Disorders - Anorexia Nervosa
Herscovici, C. R., Kovalskys, I., Orellana, L.
Although weight restoration is a crucial factor in the recovery of anorexia
nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize
research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight
gain or on improving other general outcome measures. Twenty-three AN adolescents aged 12-20 years were randomly assigned to two forms of outpatient
family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6-month duration. Their outcome was compared at the end of treatment
(EOT) and at a 6-month posttreatment follow-up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell
Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both
groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this
investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical
observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater
psychopathology. Copyright © 2015 Family Process Institute.
Family Process, 56(2) : 364-
375
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy, Other Psychological Interventions
Israely, M., Ram, A., Brandeis, R., Alter,
Z., Avraham, Y., Berry, E. M.
BACKGROUND:
Anorexia nervosa (AN) is characterized by self-induced malnutrition, affecting body image, mood, cognition and survival. Tyrosine, an essential amino
acid is the precursor of catecholamines. The use of tyrosine to treat AN is based on experiments on diet restricted mice, in which it increased food
consumption, improved cognitive function and elevated brain catecholamines. We evaluated the effect of oral tyrosine administration on the cognition
and emotional state of patients with AN. We hypothesized that tyrosine may improve cognitive function without changing body weight, thus \"kick-
start\" nutritional rehabilitation.\rMETHODS: 19 female hospitalized patients with chronic AN were supplemented with L-tyrosine (100 mg/kg/day)/
placebo capsules for a three-week period in a double blind, randomized, cross-over study. Participants were evaluated cognitively and
psychologically.\rRESULTS: Tyrosine shortened reaction time and test duration in memory tasks and improved depressive mood. No side effects were
noted with the use of tyrosine.\rCONCLUSIONS: Tyrosine may improve cognitive function and psychological traits associated with AN.
Israel Journal
of Psychiatry & Related Sciences, 54(3) : 52-58
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Herbrich, L., van-Noort, B., Pfeiffer, E., Lehmkuhl, U., Winter, S., Kappel, V.
OBJECTIVE: Cognitive remediation therapy (CRT) is a specialized treatment approach targeting cognitive weaknesses in anorexia nervosa
(AN). Regarding follow-up effects of CRT, there are only few studies available; for adolescents, there are no data.\rMETHODS: Forty-eight adolescents
with AN were assigned to receive either CRT and treatment as usual (TAU) or TAU alone. Assessments were performed at baseline (n=48) and compared
with assessments at a 6-month follow-up (n=33). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology.
\rRESULTS: The completion rate was higher in CRT compared with TAU. There were no significant differences in neuropsychological and clinical
variables. Changes in body mass index percentile showed a trend towards significance for CRT. Dropout analyses revealed no significant predictors.
\rCONCLUSIONS: Results provide a first insight into follow-up-assessments of CRT in adolescent AN. More randomized controlled studies are needed to
clarify the long-term effects of CRT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating
Disorders Review, 25(2) : 104-113
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive remediation
therapy
Hodsoll, J., Rhind, C., Micali, N., Hibbs, R., Goddard, E., Nazar, B. P., Schmidt, U., Gowers, S., Macdonald, P., Todd, G., Landau, S., Treasure, J.
Aim: The
aim of the study is to establish the acceptability, feasibility and approximate size of the effect of adding a carer intervention [Experienced
Caregivers Helping Others (ECHO)] to treatment as usual (TAU) for adolescents with anorexia nervosa. Methods: The study is a pilot randomised trial
comparing TAU (n = 50) alone or TAU plus ECHO with (n = 50) or without (n = 49) telephone guidance. Effect sizes (ESs) were regression coefficients
standardised by baseline standard deviations of measure. Results: Although engagement with ECHO was poor (only 36% of carers in the ECHO group read
over 50% of the book), there were markers of intervention fidelity, in that caregivers in the ECHO group showed a moderate increase in carer skills
(ES = 0.4) at 12 months and a reduction in accommodating and enabling behaviour at 6 months (ES = 0.17). In terms of efficacy, in the ECHO group,
carers spent less time care giving (ES = 0.40, p = 0.04) at 1 year, and patients had a minor advantage in body mass index (ES = 0.17), fewer
admissions, decreased peer problems (ES = -0.36) and more pro-social behaviours (ES = 0.53). The addition of telephone guidance to ECHO produced
little additional benefit. Conclusions: The provision of self-management materials for carers to standard treatment for adolescent anorexia nervosa
shows benefits for both carers and patients. This could be integrated as a form of early intervention in primary care. Copyright © 2017 John Wiley &
Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 25(6) : 551-
561
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Lock, J., Fitzpatrick, K. K., Agras, W. S., Weinbach, N., Jo, B.
Adolescents with anorexia nervosa who have obsessive-compulsive (OC)
features respond poorly to family-based treatment (FBT). This study evaluated the feasibility of combining FBT with either cognitive remediation
therapy (CRT) or art therapy (AT) to improve treatment response in this at-risk group. Thirty adolescents with anorexia nervosa and OC features were
randomized to 15 sessions of FBT+CRT or AT. Recruitment rate was 1 per month, and treatment attrition was 16.6% with no differences between groups.
Suitability, expectancy and therapeutic relationships were acceptable for both combinations. Correlations between changes in OC traits and changes in
cognitive inefficiencies were found for both combinations. Moderate changes in cognitive inefficiencies were found in both groups but were larger in
the FBT+AT combination. This study suggests that an RCT for poor responders to FBT because of OC traits combining FBT with either CRT or AT is
feasible to conduct. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders
Review., :
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive remediation
therapy, Family therapy, Creative expression: music, dance, drama, art
Adametz, L., Richter, F., Strauss, B., Walther, M., Wick, K., Berger, U.
Purpose: This
is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term
effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-
esteem from childhood to young adulthood. Methods: PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a
control group from 2007 to 2008 consisting of 11-13year old girls (N = 1508) from Thuringian schools in Germany. Seven to eight years after the
intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and
BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N = 100 girls were analyzed.
Results: Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the
intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem,
group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in
changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it
was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By
contrast, the control group revealed a decrease of body self-esteem over time. Conclusions: Long-term intervention effects of PriMa could be found
for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young
adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to maintain the
prevention effects, it would be interesting to investigate the effects of booster sessions which refresh the programs content on a regular basis.
Furthermore, the results of this study revealed the implementation difficulties of primary prevention programs especially concerning the retention of
the sample size. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Eating Behaviors, 25 : 42-
50
- Year: 2017
- Problem: Anorexia Nervosa
- Type: Controlled clinical trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy
McClelland, J., Kekic,
M., Bozhilova, N., Nestler, S., Dew, T., Van-den-Eynde, F. David, A. S., Rubia, K., Campbell, I. C., Schmidt, U.
BACKGROUND: Anorexia nervosa (AN) is associated with morbid fear of fatness, extreme food restriction
and altered self-regulation. Neuroimaging data implicate fronto-striatal circuitry, including the dorsolateral prefrontal cortex (DLPFC).\rMETHODS:
In this double-blind parallel group study, we investigated the effects of one session of sham-controlled high-frequency repetitive transcranial
magnetic stimulation (rTMS) to the left DLPFC (l-DLPFC) in 60 individuals with AN. A food exposure task was administered before and after the
procedure to elicit AN-related symptoms.\rOUTCOMES: The primary outcome measure was 'core AN symptoms', a variable which combined several
subjective AN-related experiences. The effects of rTMS on other measures of psychopathology (e.g. mood), temporal discounting (TD; intertemporal
choice behaviour) and on salivary cortisol concentrations were also investigated. Safety, tolerability and acceptability were assessed.\rRESULTS:
Fourty-nine participants completed the study. Whilst there were no interaction effects of rTMS on core AN symptoms, there was a trend for group
differences (p = 0.056): after controlling for pre-rTMS scores, individuals who received real rTMS had reduced symptoms post-rTMS and at 24-hour
follow-up, relative to those who received sham stimulation. Other psychopathology was not altered differentially following real/sham rTMS. In
relation to TD, there was an interaction trend (p = 0.060): real versus sham rTMS resulted in reduced rates of TD (more reflective choice behaviour).
Salivary cortisol concentrations were unchanged by stimulation. rTMS was safe, well-tolerated and was considered an acceptable intervention.
\rCONCLUSIONS: This study provides modest evidence that rTMS to the l-DLPFC transiently reduces core symptoms of AN and encourages prudent decision
making. Importantly, individuals with AN considered rTMS to be a viable treatment option. These findings require replication in multiple-session
studies to evaluate therapeutic efficacy.\rTRIAL REGISTRATION: www.Controlled-Trials.com ISRCTN22851337.
, 11(3) : e0148606
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Transcranial magnetic stimulation
(TMS)
Lackner,
N., Unterrainer, H. F., Skliris, D., Shaheen, S., Dunitz-Scheer, M., Wood, G., Scheer, P. J. Z., Wallner-
Liebmann, S. J., Neuper, C.
ABSTRACT: A pre-post design including 22 females was used to evaluate the effectiveness of neurofeedback in the treatment of
adolescent anorexia nervosa. Resting EEG measures and a psychological test-battery assessing eating behavior traits, clinical symptoms, emotionality,
and mood were obtained. While both the experimental (n = 10) and control group (n = 12) received their usual maintenance treatment, the experimental
group received 10 sessions of individual alpha frequency training over a period of 5 weeks as additional treatment. Significant training effects were
shown in eating behavior traits, emotion regulation, and in relative theta power in the eyes closed condition. Although the results are limited due
to the small sample size, these are the first empirical data demonstrating the benefits of neurofeedback as a treatment adjunct in individuals with
anorexia nervosa. Copyright © 2016 Taylor & Francis.
Eating
Disorders, 24(4) : 354-374
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Biofeedback, neurofeedback, audio/video feedback
Le-Grange, D., Hughes, E. K., Court, A., Yeo, M., Crosby, R. D., Sawyer, S. M.
Objective: There have
been few randomized clinical trials (RCTs) for adolescents with anorexia nervosa (AN). Most of these posit that involving all family members in
treatment supports favorable outcomes. However, at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as
conjoint treatment. This study compared the relative efficacy of family-based treatment (FBT) and parent-focused treatment (PFT). In PFT, the
therapist meets with the parents only, while a nurse monitors the patient. Method: Participants (N = 107) aged 12 to 18 years and meeting DSM 4th
Edition criteria for AN or partial AN were randomized to either FBT or PFT. Participants were assessed at baseline, end of treatment (EOT), and at 6
and 12 months posttreatment. Treatments comprised 18 outpatient sessions over 6 months. The primary outcome was remission, defined as >=95% of median
body mass index and Eating Disorder Examination Global Score within 1 SD of community norms. Results: Remission was higher in PFT than in FBT at EOT
(43% versus 22%; p = .016, odds ratio [OR] = 3.03, 95% CI = 1.23-7.46), but did not differ statistically at 6-month (PFT 39% versus FBT 22%; p =
.053, OR = 2.48, CI = 0.989-6.22), or 12-month (PFT 37% versus FBT 29%; p = .444, OR = 1.39, 95% CI = 0.60-3.21) follow-up. Several treatment effect
moderators of primary outcome were identified. Conclusion: At EOT, PFT was more efficacious than FBT in bringing about remission in adolescents with
AN. However, differences in remission rates between PFT and FBT at follow-up were not statistically significant. (PsycINFO Database Record (c) 2017
APA, all rights reserved)
Journal of the American Academy of Child & Adolescent
Psychiatry, 55(8) : 683-692
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Other Psychological Interventions, Other service delivery and improvement
interventions
Schmidt, U., Ryan, E.G., Bartholdy, S., Renwick, B., Keyes, A., OHara, C., McClelland, J., Lose, A., Kenyon, M., Dejong, H., Broadbent, H., Loomes, R., Serpell, L., Richards, L., Johnson-Sabine, E., Boughton,
N., Whitehead, L., Bonin, E., Beecham, J., Landau,
S., Treasure, J.
Objective: This study reports follow-up data from a multicenter randomized controlled trial (n = 142) comparing the
Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with broadly
defined anorexia nervosa (AN). At 12 months postrandomization, all patients had statistically significant improvements in body mass index (BMI),
eating disorder (ED) symptomatology and other outcomes with no differences between groups. MANTRA was more acceptable to patients. The present study
assessed whether gains were maintained at 24 months postrandomization. Methods: Follow-up data at 24 months were obtained from 73.2% of participants.
Outcome measures included BMI, ED symptomatology, distress, impairment, and additional service utilization during the study period. Outcomes were
analyzed using linear mixed models. Results: There were few differences between groups. In both treatment groups, improvements in BMI, ED
symptomatology, distress levels, and clinical impairment were maintained or increased further. Estimated mean BMI change from baseline to 24 months
was 2.16 kg/m2 for SSCM and 2.25 kg/m2 for MANTRA (effect sizes of 1.75 and 1.83, respectively). Most participants (83%) did not require any
additional intensive treatments (e.g., hospitalization). Two SSCM patients became overweight through binge-eating. Discussion: Both treatments have
value as outpatient interventions for patients with AN. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
International Journal of Eating
Disorders, 49(8) : 793-800
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions
OConnor, G., Nicholls, D., Hudson, L., Singhal, A.
BACKGROUND: Refeeding patients with
anorexia nervosa (AN) is associated with high morbidity and mortality. A lack of evidence from interventional studies has hindered refeeding practice
and led to worldwide disparities in management recommendations. In the first randomized controlled trial in this area, we tested the hypothesis that
refeeding adolescents with AN with a higher energy intake than what many guidelines recommend improved anthropometric outcomes without adversely
affecting cardiac and biochemical markers associated with refeeding.\rMATERIALS AND METHODS: Participants aged 10-16 years with a body mass index
(BMI) <78% of the median (mBMI) for age and sex were recruited from 6 UK hospitals and randomly allocated to start refeeding at 1200 kcal/d (n = 18,
intervention) or 500 kcal/d (n = 18, control).\rRESULTS: Compared with controls, adolescents randomized to high energy intake had greater weight gain
(mean difference between groups after 10 days of refeeding, -1.2% mBMI; 95% confidence interval, -2.4% to 0.0%; P = .05), but randomized groups did
not differ statistically in QTc interval and other outcomes. The nadir in postrefeeding phosphate concentration was significantly related to
percentage mBMI at the start of refeeding (baseline; P = .04) and baseline white blood cell count (P = .005) but not to baseline energy intake (P =
.08).\rCONCLUSIONS: Refeeding adolescents with AN with a higher energy intake was associated with greater weight gain but without an increase in
complications associated with refeeding when compared with a more cautious refeeding protocol-thus challenging current refeeding recommendations.
\rCopyright © 2016 American Society for Parenteral and Enteral Nutrition.
Nutrition in Clinical Practice, 31(5) : 681-
9
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Parling, T., Cernvall, M., Ramklint, M., Holmgren, S., Ghaderi, A.
Background: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance
factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed
to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12 weeks of daycare, regarding recovery and risk of relapse up to five years.
Methods: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n = 24)
and TAU (n = 19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary
outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios.
Results: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There
were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was
underpowered due to unexpected low inflow of patients and high attrition. Conclusion: Longer treatment, more focus on established perpetuating
factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. (PsycINFO
Database Record (c) 2016 APA, all rights reserved)
BMC Psychiatry Vol 16 2016, ArtID 272, 16 :
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)