Disorders - Anorexia Nervosa
Boerhout, C., Swart, M., Van-Busschbach, J. T., Hoek, H. W.
OBJECTIVE: The objective of the study is to evaluate the effect of a brief body and movement oriented intervention on aggression
regulation and eating disorder pathology for individuals with eating disorders.\rMETHOD: In a first randomized controlled trial, 40 women were
allocated to either the aggression regulation intervention plus supportive contact or a control condition of supportive contact only. The
intervention was delivered by a psychomotor therapist. Participants completed questionnaires on anger coping and eating disorder pathology.
Independent samples t-tests were performed on the difference between pre-treatment and post-treatment scores.\rRESULTS: Twenty-nine participants
completed questionnaires at pre-intervention and post-intervention. The intervention resulted in a significantly greater improvement of anger coping,
as well as of eating disorder pathology.\rDISCUSSION: Results indicate that body and movement-oriented aggression regulation may be a viable add-on
for treating eating disorders. It tackles a difficult to treat emotion which may have a role in blocking the entire process of treating eating
disorders.\rCopyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders
Review, 24(2) : 114-21
- Year: 2016
- Problem: Anorexia Nervosa, Binge Eating Disorders, 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
Eisler,
I., Simic, M., Hodsoll, J., Asen, E., Berelowitz, M., Connan, F., Ellis, G., Hugo, P., Schmidt, U., Treasure, J., Yi, I., Landau, S.
Background: Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia
nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family
Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment
developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the
results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa. Methods: The study was a pragmatic
multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy
(MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise
specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the
trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.
Results: Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the
Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in
favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little
change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant.
Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients
in FT-AN and nearly 60% of those in MFT-AN had started menstruating. Conclusions: This study confirms previous research findings demonstrating the
effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises
the use of family resources and mutual support leading to improved outcomes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
BMC Psychiatry Vol 16 2016, ArtID
422, 16 :
- Year: 2016
- Problem: Anorexia Nervosa, Eating disorders not specified
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Other service delivery and improvement
interventions
Fernandez-del-Valle, M., Larumbe-Zabala, E., Morande-Lavin, G., Perez-Ruiz, M.
PURPOSE: The aim of this study
was to analyze the effects of short-term resistance training on the body composition profile and muscle function in a group of Anorexia Nervosa
restricting type (AN-R) patients. METHODS: The sample consisted of AN-R female adolescents (12.8+/-0.6 years) allocated into the control and
intervention groups (n=18 each). Body composition and relative strength were assessed at baseline, after 8 weeks and 4 weeks following the
intervention. RESULTS: Body mass index (BMI) increased throughout the study (p=0.011). Significant skeletal muscle mass (SMM) gains were found in the
intervention group (p=0.045, d=0.6) that correlated to the change in BMI (r=0.51, p<0.031). Meanwhile, fat mass (FM) gains were significant in the
control group (p=0.047, d=0.6) and correlated (r>0.60) with change in BMI in both the groups. Significant relative strength increases (p<0.001) were
found in the intervention group and were sustained over time. CONCLUSIONS: SMM gain is linked to an increased relative strength when resistance
training is prescribed. Although FM, relative body fat (%BF), BMI and body weight (BW) are used to monitor nutritional progress. Based on our
results, we suggest to monitor SMM and relative strength ratios for a better estimation of body composition profile and muscle function recovery.
Implications for Rehabilitation Anorexia Nervosa Restricting Type (AN-R) AN-R is a psychiatric disorder that has a major impact on muscle mass
content and function. However, little or no attention has been paid to muscle recovery. High intensity resistance training is safe for AN-R after
hospitalization and enhances the force generating capacity as well as muscle mass gains. Skeletal muscle mass content and muscular function
improvements are partially maintained for a short period of time when the exercise program ceases.
Disability and rehabilitation, 38(4) : 346-
353
- Year: 2016
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Dold, M., Aigner, M., Klabunde, M., Treasure, J., Kasper, S.
Background:
Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we
aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the 'World
Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update
literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in
comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were
mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature
discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios
were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found
no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17
to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no
treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be
generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required
to identify which patients will likely benefit from such a treatment option.
Psychotherapy & Psychosomatics, 84(2) : 110-116
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Atypical Antipsychotics (second
generation), Psychological Interventions
(any)
Fernandez-del-Valle, M., Larumbe-Zabala, E., Graell-Berna, M., Perez-Ruiz, M.
Purpose: The follow-up of anthropometric percentiles such as triceps and mid-
thigh skinfold thickness (TSF, MTSF), mid-upper arm and mid-thigh circumferences (MUAC, MTC), and arm and mid-thigh muscle areas (AMA, MTMA) after a
resistance training might allow for detecting nutritional progress of fat and muscular tissue during the treatment of anorexia nervosa restricting
(AN-R) type patients. Methods: A total of 44 AN-R patients were randomized for control (CG 13.0 +/- 0.6 years) and intervention (IG 12.7 +/- 0.7
years) groups after hospitalization. The intervention group underwent a resistance training program of 8 weeks following the guidelines for healthy
adolescents (3 days/week; 70 % of 6 RM). All measurements were obtained prior to starting the program (PRE) and after 8 weeks of training (POST) in
both groups. TSF, MTSF, MUAC, and MTC were measured, and AMA and MTMA were calculated. Data were matched with percentile tables for general
population. Changes were assessed using statistical tests for categorical data. Results: The distribution of percentile categories within the groups
did not differ statistically after 8 weeks (p > 0.05). After training, 73 % of the patients were at the same percentile interval of MUAC, 18 % higher
and 9 % lower, while 30 % of CG was at lower percentile categories. Further, 54 % of the IG patients remained at the same percentile interval of MTC
after training, and 36 % higher, while 20 % were at lower categories in the CG. The AMA increased (32 %) after training or remained at the same
interval (59 %) in the IG, while the IG showed greater frequency of percentile decreases (45 %). Conclusions: Anthropometric measurements could be
useful for assessing muscle status in AN-R patients during the treatment process. However, exact standard deviation scores should be used instead of
percentile categories to increase the sensitivity to changes in TSF, MTSF, MUAC, MTC or AMA. (PsycINFO Database Record (c) 2016 APA, all rights
reserved) (journal abstract).
Eating & Weight
Disorders, 20(3) : 311-317
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Godart, N., Radon, L., Duclos, J., Berthoz, S., Perdereau, F., Curt, F., Rein, Z., Wallier, J., Horreard, A. S., Kaganski, I., Lucet, R., Corcos, M., Fermanian, J., Falissard, B., Flament, M., Jeammet, P.
Context:
Long term follow-up for evidence-based treatment trials for post-hospitalisation treatment of adolescent outpatients with severe anorexia nervosa
(AN) are scarce. Objective: To compare two multidimensional post hospitalization outpatient treatment programs (identical except that one included
family therapy) for adolescents with severe AN. Design: Randomized controlled trial conducted from January 21st, 1999 to July 22nd, 2002 and followed
until 2014. Setting: At the Institut Mutualiste Montsouris, René Descartes University of Paris, ambulatory post-hospitalization care. Patients: Sixty
female adolescents with DSM-IV AN, aged 13 to 19 years. Interventions: The first group, \"Treatment as Usual\" (TAU) included sessions for the
adolescent alone and sessions with a psychiatrist for the adolescent with her parents. Treatment for the second group (TAU + FT) was identical to TAU
but also included a family therapy component targeting intra-familial dynamic but not eating disorder symptoms. Main Outcome Measure: Morgan and
Russell Score (good or intermediate outcome versus poor outcome) at 18 months of follow up. Our secondary outcomes index were the Global Outcome
Assessment Scale total score and AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the
course of follow-up, and social adaptation). Results: After 18-months of follow-up, significant differences were found between the two programs in
the numbers achieving a Good or Intermediate Outcome score on the Morgan and Russell Scales. TAU + FT was more effective than TAU (Intention to Treat
analysis: TAU + FT Similar results where observed regarding weight outcome and menstrual status at 54 months follow-up and 13 years. We will expose
in addition outcome of the two groups. Conclusion: Adding FT, that has a principle focusing on intra-familial dynamic, to a multidimensional program
already involving parents improves treatment effectiveness in severe AN patients even after 13 years follow up.
European Child & Adolescent Psychiatry, 24(1) : S112
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Family therapy
Ciao, A. C., Accurso, E.
C., Fitzsimmons-Craft, E. E., Lock, J., Le-Grange, D.
Objective: Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of
family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from
multiple family members' perspectives. Method: Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing
family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family
functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN
was defined as achieving both weight restoration and normalized eating disorder psychopathology. Results: In general, families dealing with AN
reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning
cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning
and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely
related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family
functioning compared to AFT. Discussion: Families seeking treatment for adolescent AN report some difficulties in family functioning, with
adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN
was associated with improved family dynamics, regardless of treatment type. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal
abstract).
International Journal of Eating
Disorders, 48(1) : 81-90
- 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
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le-Grange, D., Jo, B., Clarke, S., Rhodes, P., Hay, P., Touyz, S.
BACKGROUND: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International
treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial
hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This
study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN. METHOD: We
performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted
to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected
body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT). RESULTS: The
primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of
hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score
within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial
admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary
outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group. CONCLUSIONS:
Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with
FBT.
Psychological Medicine, 45(2) : 415-
427
- Year: 2015
- Problem: Anorexia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions, Service Delivery & Improvement, Psychological Interventions
(any), Family therapy, Other service delivery and improvement
interventions
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