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Flatt RE, Miller AJ, Foreman T, Shannon J. Considerations for Athletes with Eating Disorders Based on Levels of Care. Curr Sports Med Rep 2022; 21:92-99. [PMID: 35245244 DOI: 10.1249/jsr.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article provides an overview of levels of care for eating disorders (EDs) and considerations that are specific to elite athletes. We discuss the following levels of care in terms of ED pathology and treatment aspects that may be unique to athletes: 1) inpatient and residential care, 2) intensive outpatient and partial hospitalization treatment, and 3) outpatient. Illustrative case studies also are presented to highlight distinctions between levels of care and athlete-specific nuances to treatment approaches and health care teams. Finally, we review aspects of return to play plans for elite athletes with EDs.
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Affiliation(s)
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tonya Foreman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeni Shannon
- Department of Sports Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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2
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Yoga as an Integrative Therapy for Mental Health Concerns: An Overview of Current Research Evidence. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2040030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Because the prevalence of mental health concerns is high and access or full responsiveness to pharmacological or psychotherapeutic treatment for many individuals is low, there has been increased interest in yoga as a potential therapy for many mental health concerns. Approach: We synthesize and critique current research on the efficacy of yoga relative to pharmacological approaches for anxiety disorders, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Results: Yoga has been tested mostly as a complementary treatment to standard psychiatric and psychotherapeutic approaches. Findings from efficacy trials largely support the notion that yoga can help reduce symptoms of many psychiatric conditions, including anxiety, depression, and PTSD symptoms, above and beyond the effects achieved by standard pharmacological treatments alone; however, most evidence is of poor to moderate quality. Plausible transdiagnostic bottom-up and top-down mechanisms of yoga’s therapeutic effects have been advanced but remain untested. Conclusions: While results should be considered preliminary until more rigorous evidence is available, yoga appears to have the potential to provide many people suffering with psychiatric symptoms additional relief at relatively little cost. Yoga may be a viable complementary therapy to psychiatric and psychotherapeutic approaches for people with mental health challenges.
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3
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Rizzuto L, Hay P, Noetel M, Touyz S. Yoga as adjunctive therapy in the treatment of people with anorexia nervosa: a Delphi study. J Eat Disord 2021; 9:111. [PMID: 34496949 PMCID: PMC8425123 DOI: 10.1186/s40337-021-00467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN. METHODS A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts' understanding of the term yoga and opinions on its' use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations. RESULTS Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its' general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice. CONCLUSIONS It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted. This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). Experts were asked about their understanding of the term yoga and their opinions on its' use in therapy. The panel reached consensus on items defining yoga and pertaining to its' general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.
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Affiliation(s)
- Laura Rizzuto
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Greater Western Sydney, Australia.
| | | | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, Australia
- InsideOut Institute University of Sydney, Sydney, Australia
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4
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Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, Myers EM, Richmond TK, Samnaliev M, Velasquez K, Weissman RS, Pezzullo L. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord 2021; 54:851-868. [PMID: 33655603 DOI: 10.1002/eat.23486] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate one-year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S. METHOD Costs of eating disorders were estimated using a bottom-up cost-of-illness methodology, based on the estimated one-year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years. RESULTS Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5-$66.0 billion) in fiscal year 2018-2019, equivalent to $11,808 per affected person (95% CI: $11,754-$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8-$336.2 billion). DISCUSSION The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018-2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence-based treatment.
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Affiliation(s)
- Jared Streatfeild
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - Josiah Hickson
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
| | - S Bryn Austin
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Rebecca Hutcheson
- Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA.,School of Public Health, University of Washington, Seattle, Washington, USA
| | - Johanna S Kandel
- Alliance for Eating Disorders Awareness, West Palm Beach, Florida, USA
| | - Jillian G Lampert
- The Emily Program, St Paul, Minnesota, USA.,REDC Consortium (REDC), New York, New York, USA
| | | | - Tracy K Richmond
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | - Mihail Samnaliev
- Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Strategic Training Initiative for the Prevention of Eating Disorders, Boston, Massachusetts, USA
| | | | - Ruth S Weissman
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Lynne Pezzullo
- Deloitte Access Economics, Canberra, Australian Capital Territory, Australia
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5
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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6
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Diers L, Rydell SA, Watts A, Neumark-Sztainer D. A yoga-based therapy program designed to improve body image among an outpatient eating disordered population: program description and results from a mixed-methods pilot study. Eat Disord 2020; 28:476-493. [PMID: 32421457 DOI: 10.1080/10640266.2020.1740912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Poor body image is a critical barrier to eating disorder recovery. This pilot project was designed as a feasibility study to examine a novel group-based, therapeutic yoga and body image program (YBI) for addressing negative body image in those clinically diagnosed with an eating disorder (anorexia, bulimia nervosa, and other specified feeding or eating disorder) receiving outpatient level treatment at an eating disorder treatment center located in Minneapolis-St. Paul, Minnesota. Self-administered questionnaires were completed by 67 participants at the beginning and end of the 8-week series, to better understand the acceptability of the YBI program and its potential effects on body image and self-worth during outpatient eating disorder treatment. Quantitative survey questions assessed participants' body image concerns, while open-ended questions probed participants' experiences and the perceived impact of the yoga program on their body image. After completion of the yoga program, mean item scores on the body image concern survey improved: increases ranged from 0.3 to 0.8 points on a 5-point scale. In open-ended questions, participants described many positive changes to their body image. Participants reported that the yoga program improved their self-acceptance, self-awareness, confidence, emotional and physical strength, and was a positive form of release. Participants also discussed physical and emotional challenges of the yoga program and how they contributed to self-judgment, vulnerability, and confrontation of uncomfortable feelings. The results of this pilot study are promising and warrant consideration of more rigorous study designs to explore the potential of a body image specific therapeutic yoga program to aid those in eating disorder treatment to improve body image disturbances.
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Affiliation(s)
- Lisa Diers
- Private Practice, Lisa Diers Yoga and Nutrition Consulting, LLC , Minneapolis, MN, USA
| | - Sarah A Rydell
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota , Minneapolis, MN, USA
| | - Allison Watts
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota , Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota , Minneapolis, MN, USA
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7
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Herpertz-Dahlmann B, Borzikowsky C, Altdorf S, Heider K, Dempfle A, Dahmen B. 'Therapists in action'-Home treatment in adolescent anorexia nervosa: A stepped care approach to shorten inpatient treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 29:427-442. [PMID: 32558214 DOI: 10.1002/erv.2755] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It was the aim of this pilot study to apply a novel eating disorder (ED)-specific home treatment (HoT) to adolescents with anorexia nervosa (AN) and to investigate its feasibility, effects and safety. METHOD Twenty-two patients consecutively admitted to the hospital and fulfilling DSM-5 criteria for typical or atypical AN received HoT after 4-8 weeks of inpatient treatment. During the first two months of HoT, the patient and her family were visited on average three to four times per week, during the third and fourth months of HoT once or twice a week by a multi-professional team. Body mass index, ED and general psychopathology, quality of life and treatment satisfaction were assessed in the patients at admission, start and end of HoT and the 1-year follow-up as well as carers' skills and burden. RESULTS The majority of patients successfully achieved target weight within HoT and maintained it successfully at the 1-year follow-up. ED and general psychopathology in the patients and carers' skills improved significantly associated with a high treatment satisfaction. CONCLUSIONS HoT seems to be a promising new tool to improve outcome in adolescent AN and to reduce time of hospitalisation. Larger randomised controlled trials are needed to generalise these results.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie Altdorf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Kathrin Heider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
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8
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Peckmezian T, Paxton SJ. A systematic review of outcomes following residential treatment for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:246-259. [PMID: 32196843 PMCID: PMC7216912 DOI: 10.1002/erv.2733] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/05/2020] [Accepted: 03/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Residential centres for the treatment of eating disorders are becoming increasingly common, yet data following residential care are scarce. We reviewed outcomes of residential treatment for eating disorders across all diagnoses, age groups and genders. A secondary goal was to identify treatment elements and patient characteristics that predicted a greater response to treatment. METHOD Peer-reviewed studies published in the last 20 years were identified through a systematic search of the electronic databases PubMed and Cochrane Library. RESULTS Nineteen open-label studies reporting changes between admission and discharge were included in this review. Most took an eclectic approach to treatment, integrating elements from several different techniques without a unifying theoretical framework. All studies reported improvements in most outcomes at discharge, including changes in eating disorders psychopathology, weight, depression, anxiety and quality of life. Eight studies reported outcomes at some interval after discharge, with largely positive outcomes. CONCLUSIONS While residential care was associated with consistently positive outcomes, the variability in program characteristics and poor quality of research designs prevent firm conclusions from being drawn about their efficacy. Future research should include controlled studies that evaluate specific theoretical approaches and program elements, include long-term follow-up, and compare residential care to other treatment settings.
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Affiliation(s)
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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9
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Espel-Huynh H, Thompson-Brenner H, Boswell JF, Zhang F, Juarascio AS, Lowe MR. Development and validation of a progress monitoring tool tailored for use in intensive eating disorder treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 28:223-236. [PMID: 31994259 PMCID: PMC7086406 DOI: 10.1002/erv.2718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Despite calls for routine use of progress and outcome monitoring in private and intensive treatment centres for eating disorders (EDs), existing measures have limited relevance to these supervised treatment settings. This study sought to develop and validate the progress monitoring tool for eating disorders, a multidimensional measure for progress monitoring in the context of intensive ED treatment. METHOD Thirty-seven items were generated by a team of content experts, clinicians, and administrative staff from the target treatment setting. Adolescent and adult females (N = 531) seeking residential ED treatment completed the items at admission as part of the clinic's routine assessment battery; 83% were retained for repeat assessment at discharge. Exploratory factor analysis was conducted for preliminary measure development. RESULTS Results yielded a five-factor, 26-item structure explaining 50% of total variance. Final construct domains included weight and shape concern, ED behaviours and urges, emotion avoidance, adaptive coping, and relational connection. The measure demonstrated adequate internal consistency, sensitivity to change during treatment, and convergence with validated assessment measures. CONCLUSIONS Preliminary data support the progress monitoring tool for eating disorders as a novel and valid multidimensional measure of treatment-relevant constructs. This measure may have utility in measuring treatment progress for patients receiving intensive treatment for EDs.
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Affiliation(s)
| | | | | | | | | | - Michael R. Lowe
- Drexel University, Philadelphia, PA, USA
- The Renfrew Center, Philadelphia, PA, USA
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10
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Fisher M, Henretty JR, Cox SA, Feinstein R, Fornari V, Moskowitz L, Schneider M, Levine S, Malizio J, Fishbein J. Demographics and Outcomes of Patients With Eating Disorders Treated in Residential Care. Front Psychol 2020; 10:2985. [PMID: 32010027 PMCID: PMC6978748 DOI: 10.3389/fpsyg.2019.02985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022] Open
Abstract
The use of residential eating disorder (ED) treatment has grown dramatically in the United States, yet there has been minimal evaluation of treatment outcomes. Thus, outcome data on weight restoration, purging behaviors, and/or Global Assessment of Functioning (GAF) for 1,421 patients treated over an 8-year period in residential ED programs are described. Results suggest that, (1) for patients who needed weight restoration upon admission, adolescent and adult patients gained 2.0 and 2.1 lb/week, respectively; (2) of patients who reported purge behavior the month before admission, 89.1% were able to completely cease purging while in treatment; (3) although improvement of approximately 10 mean GAF points was made during treatment, patients were still quite impaired at discharge; and (4) mean length of stay was 12 days longer for adolescents than adults, and 10–15 days longer for patients diagnosed with anorexia compared to bulimia or ED Not Otherwise Specified (EDNOS), respectively. Other demographic statistics and additional analyses are presented. Limitations include the high variance of purging data and reliance on self- and parent-report for admission data. The data on the 1,421 patients, which represents 96% of all patients treated during the study period, more than doubles the number of residential ED patients with outcome in the literature.
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Affiliation(s)
- Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States.,Hofstra-Northwell School of Medicine, Hempstead, NY, United States
| | - Jennifer R Henretty
- Department of Outcomes and Research, Center For Discovery, Los Alamitos, CA, United States
| | - Shelbi A Cox
- Department of Outcomes and Research, Center For Discovery, Los Alamitos, CA, United States
| | - Ronald Feinstein
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States.,Hofstra-Northwell School of Medicine, Hempstead, NY, United States
| | - Victor Fornari
- Hofstra-Northwell School of Medicine, Hempstead, NY, United States.,Division of Child and Adolescent Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, United States
| | - Lindsay Moskowitz
- Hofstra-Northwell School of Medicine, Hempstead, NY, United States.,Division of Child and Adolescent Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, United States
| | | | - Sara Levine
- Greenwich Adolescent Medicine, Greenwich, CT, United States
| | - Joan Malizio
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Joanna Fishbein
- Biostatistics Unit, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
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11
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Reilly EE, Rockwell RE, Ramirez AL, Anderson LK, Brown TA, Wierenga CE, Kaye WH. Naturalistic outcomes for a day-hospital programme in a mixed diagnostic sample of adolescents with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:199-210. [PMID: 31925866 DOI: 10.1002/erv.2716] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/07/2019] [Accepted: 12/09/2019] [Indexed: 01/04/2023]
Abstract
Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry, University of California, San Diego, CA.,Department of Psychology, Hofstra University, Hempstead, NY
| | | | - Ana L Ramirez
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, CA.,VA San Diego Healthcare System, San Diego, CA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA
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12
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Abstract
This article provides background information, descriptions, and evidential support for the more recent treatments for adolescents with anorexia nervosa, including family-based treatment, adolescent focused therapy, cognitive behavioral therapy, systemic family therapy, and psychopharmacologic treatments. At this time, family-based treatment has the best evidence of efficacy and cost-effectiveness. Future directions in treatment research for adolescent anorexia nervosa are discussed.
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Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
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13
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Abstract
Many eating disorder patients are successfully treated in outpatient settings. Family-based treatment allows youth to recover at home. Higher levels of care may be necessary for medical or psychiatric stabilization, or to provide added structure. Historically, hospital lengths of stay were long. Currently, insurance limitations encourage intermediate care levels to support patients not requiring inpatient treatment but not ready for outpatient care. Options include inpatient medical stabilization, locked units for individuals with suicidal ideation, and outpatient programs offering daily meal support and group therapy. Outpatient teams and families collaborate to determine the appropriate level of care.
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Affiliation(s)
- Jennifer Derenne
- Division of Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94304, USA.
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14
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Saunders JF, Eaton AA, Fitzsimmons-Craft EE. Body-, Eating-, and Exercise-Related Comparisons During Eating Disorder Recovery and Validation of the BEECOM-R. PSYCHOLOGY OF WOMEN QUARTERLY 2019. [DOI: 10.1177/0361684319851718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Social comparison tendencies are strongly associated with body dissatisfaction and disordered eating. In the current study, we quantitatively examined the structure and predictive value of these constructs during eating disorder recovery. We revised an existing measure of body-, eating-, and exercise-related social comparisons, the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM), to improve psychometric properties. We also assessed the psychometric properties of the shortened Body, Eating, and Exercise Comparison Orientation Measure-Revised (BEECOM-R) in a comparison sample, resulting in an abbreviated measure suitable for recovering, clinical, and non-clinical samples. Finally, we used the revised measure to examine the additive influence of body-, eating-, and exercise-related comparisons on shape and weight dissatisfaction and disordered eating cognitions among 150 women (ages of 18–35 years) in self-identified recovery. Results suggest that body-, eating-, and exercise-related social comparisons all continue to correlate with body dissatisfaction and disordered eating during recovery. A minority of participants reported these comparisons to be helpful during the recovery process. We recommend social comparison as a clinical target for most women seeking support for eating pathology. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/ 10.1177/0361684319851718
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Affiliation(s)
- Jessica F. Saunders
- Women’s Research Institute of Nevada, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Asia A. Eaton
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
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15
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Latzer Y. Stopping the "revolving door": "Zeida Laderech," a unique rehabilitation house for young adults with severe and enduring eating disorders. J Clin Psychol 2019; 75:1469-1481. [PMID: 30995354 DOI: 10.1002/jclp.22791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A failure to maintain improvement achieved during acute treatment, followed by a "revolving door syndrome," is a common phenomenon in eating disorders (EDs). As a result, many patients develop a chronic course that is difficult to treat. To target these difficulties, we established a novel rehabilitation treatment model in Israel for patients with severe and enduring EDs, based on the "recovery theory" in mental health treatment. This paper describes the process of conceiving this model and specifies the components of this rehabilitation house, "Zeida Laderech" (Provisions for the Journey), that aims to provide a home-like environment, while assisting in developing a healthy and balanced lifestyle. Finally, the model is discussed in light of other residential programs established in the world. With the hope to improve the overall prognosis of individuals with EDs, it is suggested that the similar programs and ongoing innovation will continue to emerge internationally.
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Affiliation(s)
- Yael Latzer
- School of Social Work, Faculty of Social Welfare and Health Science, Haifa University, Haifa, Israel.,Eating Disorders Institution, Psychiatric Devision, Rambam Medical Center, Haifa, Israel
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Kim SK, Annunziato RA, Olatunji BO. Profile analysis of treatment effect changes in eating disorder indicators. Int J Methods Psychiatr Res 2018; 27:e1599. [PMID: 29168266 PMCID: PMC6877274 DOI: 10.1002/mpr.1599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/07/2022] Open
Abstract
We investigated differential treatment effects on specific eating disorder (ED) indicators to enhance conclusions about treatment efficacy. Profile Analysis via Multidimensional Scaling, which identifies core profiles in a population and interprets person profiles with core profile information, was utilized to identify core profiles from a sample of 5,177 patients who were repeatedly measured with the ED inventory-2 at admission and at discharge. To assess differential treatment effects for individual ED indicators, we compared the core profiles at admission with those at discharge. Three core profiles were identified and labeled as High Body Dissatisfaction with Low Bulimia (Core Profile 1), High Interoceptive Awareness with Low Body Dissatisfaction (Core Profile 2), and High Ineffectiveness with Low Bulimia (Core Profile 3). Treatment had the greatest effects on Core Profile 2. The patients whose profile patterns were similar to that of Core Profiles 1 and 2 were positively related with weight gain. However, treatment was least on Core Profile 3, and the patients whose profile patterns were like that of Core Profile 3 were negatively related with weight gain. In conclusion, those patients who fit Core Profile 3 may benefit from different treatment modalities than those that are standard in inpatient settings.
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Affiliation(s)
- Se-Kang Kim
- Department of Psychology, Fordham University, Bronx, New York, USA
| | | | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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Thompson-Brenner H, Boswell JF, Espel-Huynh H, Brooks G, Lowe MR. Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation. Psychother Res 2018; 29:1045-1061. [DOI: 10.1080/10503307.2018.1446563] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - James F. Boswell
- Department of Psychology, University at Albany, SUNY, Albany, NY, USA
| | | | | | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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18
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Thompson-Brenner H, Brooks GE, Boswell JF, Espel-Huynh H, Dore R, Franklin DR, Gonçalves A, Smith M, Ortiz S, Ice S, Barlow DH, Lowe MR. Evidence-based implementation practices applied to the intensive treatment of eating disorders: Summary of research and illustration of principles using a case example. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12221] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Susan Ice
- The Renfrew Centers; Philadelphia PA USA
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19
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An adjunctive, museum-based art therapy experience in the treatment of women with severe eating disorders. ARTS IN PSYCHOTHERAPY 2017. [DOI: 10.1016/j.aip.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Kapphahn CJ, Graham DA, Woods ER, Hehn R, Mammel KA, Forman SF, Fisher M, Robinson KA, Rome ES, Hergenroeder A, Golden NH. Effect of Hospitalization on Percent Median Body Mass Index at One Year, in Underweight Youth With Restrictive Eating Disorders. J Adolesc Health 2017; 61:310-316. [PMID: 28587796 DOI: 10.1016/j.jadohealth.2017.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Data from low-weight patients with restrictive eating disorders (EDs) treated in outpatient adolescent medicine-based ED treatment programs were analyzed to determine whether there was an association between hospitalization and gain to at least 90% median body mass index (mBMI) at 1-year follow-up. METHODS Data were retrospectively collected for 322 low-weight (<85% mBMI at intake) patients aged 9-21 years, who presented with restrictive EDs to 14 adolescent medicine-based ED programs in 2010. Positive outcome was defined as being at least 90% mBMI (%mBMI = patient's body mass index/mBMI for age × 100) at 1-year follow-up. Association between treatment at a higher level of care and gain to at least 90% mBMI was analyzed for 140 patients who were <85% mBMI at the time of presentation, had not been previously hospitalized, and had 1-year follow-up data available. RESULTS For patients presenting at <85% mBMI, those who were hospitalized in the year following intake had 4.0 (95% confidence interval: 1.6-10.1) times the odds of gain to at least 90% mBMI, compared with patients who were not hospitalized, when controlling for baseline %mBMI. CONCLUSION In this national cohort of patients with restrictive EDs presenting to adolescent medicine-based ED programs at <85% mBMI, those who were hospitalized had greater odds of being at least 90% mBMI at 1-year follow-up.
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Affiliation(s)
- Cynthia J Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
| | - Dionne A Graham
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth R Woods
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca Hehn
- Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts
| | - Kathleen A Mammel
- Division of Adolescent Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; Formerly of Department of Adolescent Pediatrics, Beaumont Children's Hospital, Royal Oak, Michigan
| | - Sara F Forman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York; Department of Pediatrics, Hofstra-Northwell Health School of Medicine, Hempstead, New York
| | - Kelly A Robinson
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Ellen S Rome
- Department of General Pediatrics, Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Albert Hergenroeder
- Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Neville H Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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21
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Guarda AS, Schreyer CC, Fischer LK, Hansen JL, Coughlin JW, Kaminsky MJ, Attia E, Redgrave GW. Intensive treatment for adults with anorexia nervosa: The cost of weight restoration. Int J Eat Disord 2017; 50:302-306. [PMID: 28130794 DOI: 10.1002/eat.22668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Weight restoration in anorexia nervosa (AN) is associated with lower relapse risk; however rate of weight gain and percent of patients achieving weight restoration (BMI ≥ 19 at discharge) vary among treatment programs. We compared both cost/pound of weight gained and cost of weight restoration in a hospital-based inpatient (IP)-partial hospitalization (PH) eating disorders program to estimates of these costs for residential treatment. METHOD All adult first admissions to the IP-PH program with AN (N = 314) from 2003 to 2015 were included. Cost of care was based on hospital charges, rates of weight gain, and weight restoration data. Results were compared with residential treatment costs extracted from a national insurance claims database and published weight gain data. RESULTS Average charge/day in the IP-PH program was $2295 for IP and $1567 for PH, yielding an average cost/pound gained of $4089 and $7050, respectively, with 70% of patients achieving weight restoration. Based on published mean weight gain data and conservative cost/day estimates, residential treatment is associated with higher cost/pound, and both higher cost and lower likelihood of weight restoration for most patients. DISCUSSION The key metrics used in this study are recommended for comparing the cost-effectiveness of intensive treatment programs for patients with AN.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura K Fischer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer L Hansen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Kaminsky
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Medical Center, New York.,Department of Psychiatry, Weill Cornell Medical College, New York
| | - Graham W Redgrave
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pacanowski CR, Diers L, Crosby RD, Neumark-Sztainer D. Yoga in the treatment of eating disorders within a residential program: A randomized controlled trial. Eat Disord 2017; 25:37-51. [PMID: 27723416 PMCID: PMC5982102 DOI: 10.1080/10640266.2016.1237810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To investigate the effect of yoga on negative affect (an eating disorders risk factor), 38 individuals in a residential eating disorder treatment program were randomized to a control or yoga intervention: 1 hour of yoga before dinner for 5 days. Negative affect was assessed pre- and post-meal. Mixed-effects models compared negative affect between groups during the intervention period. Yoga significantly reduced pre-meal negative affect compared to treatment as usual; however, the effect was attenuated post-meal. Many eating disorders programs incorporate yoga into treatment. This preliminary evidence sets the stage for larger studies examining yoga and eating disorder treatment and prevention.
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Affiliation(s)
- Carly R Pacanowski
- a Department of Behavioral Health and Nutrition, College of Health Sciences , University of Delaware , Newark , Delaware , USA
| | - Lisa Diers
- b The Emily Program , St. Paul , Minnesota , USA
| | - Ross D Crosby
- c The Neuropsychiatric Research Institute , Fargo , North Dakota , USA.,d The University of North Dakota School of Medicine and Health Sciences , University of North Dakota , Fargo , North Dakota , USA
| | - Dianne Neumark-Sztainer
- e Division of Epidemiology & Community Health, School of Public Health , University of Minnesota , Minneapolis , Minnesota , USA
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Smith K, Lesser J, Brandenburg B, Lesser A, Cici J, Juenneman R, Beadle A, Eckhardt S, Lantz E, Lock J, Le Grange D. Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota. J Eat Disord 2016; 4:35. [PMID: 28018595 PMCID: PMC5165845 DOI: 10.1186/s40337-016-0124-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historically, inpatient protocols have adopted relatively conservative approaches to refeeding in Anorexia Nervosa (AN) in order to reduce the risk of refeeding syndrome, a potentially fatal constellation of symptoms. However, increasing evidence suggests that patients with AN can tolerate higher caloric prescriptions during treatment, which may result in prevention of initial weight loss, shorter hospital stays, and less exposure to the effects of severe malnutrition. Therefore the present study sought to examine the effectiveness of a more accelerated refeeding protocol in an inpatient AN and atypical AN sample. METHODS Participants were youth (ages 10-22) with AN (n = 113) and atypical AN (n = 16) who were hospitalized for medical stabilization. A retrospective chart review was conducted to assess changes in calories, weight status (percentage of median BMI, %mBMI), and indicators of refeeding syndrome, specifically hypophosphatemia, during hospitalization. Weight was assessed again approximately 4 weeks after discharge. RESULTS No cases of refeeding syndrome were observed, though 47.3 % of participants evidenced hypophosphatemia during treatment. Phosphorous levels were monitored in all participants, and 77.5 % were prescribed supplemental phosphorous at the time of discharge. Higher rates of caloric changes were predictive of greater changes in %mBMI during hospitalization. Rates of caloric and weight change were not related to an increased likelihood of re-admission. CONCLUSIONS Results suggest that a more accelerated approach to inpatient refeeding in youth with AN and atypical AN can be safely implemented and is not associated with refeeding syndrome, provided there is close monitoring and correction of electrolytes. These findings suggest that this approach has the potential to decrease length of stay and burden associated with inpatient hospitalization, while supporting continued progress after hospitalization.
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Affiliation(s)
- Kathryn Smith
- Neuropsychiatric Research Institute, Fargo, North Dakota USA
| | - Julie Lesser
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota USA
| | - Beth Brandenburg
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota USA
| | - Andrew Lesser
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania USA
| | - Jessica Cici
- Fairview Health Services, Minneapolis, Minnesota USA
| | - Robert Juenneman
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota USA
| | - Amy Beadle
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota USA
| | - Sarah Eckhardt
- Children’s Hospitals and Clinics of Minnesota, Minneapolis, Minnesota USA
| | - Elin Lantz
- Drexel University, Philadelphia, Pennsylvania USA
| | - James Lock
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California USA
| | - Daniel Le Grange
- University of California, San Francisco Department of Psychiatry, San Francisco, California USA
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24
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Goldstein MA, Alinsky R, Medeiros C. Males With Restrictive Eating Disorders: Barriers to Their Care. J Adolesc Health 2016; 59:371-2. [PMID: 27664463 DOI: 10.1016/j.jadohealth.2016.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Mark A Goldstein
- Division of Adolescent and Young Adult Medicine, MassGeneral Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rachel Alinsky
- Departments of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cathryn Medeiros
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri
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25
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Twohig MP, Bluett EJ, Cullum JL, Mitchell PR, Powers PS, Lensegrav-Benson T, Quakenbush-Roberts B. Effectiveness and clinical response rates of a residential eating disorders facility. Eat Disord 2016. [PMID: 26214231 DOI: 10.1080/10640266.2015.1064279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine the effectiveness of a residential treatment program for adults and adolescents with eating disorders across a wide spectrum of measures. Data on body mass, eating disorder severity, depression, anxiety, and two measures of quality of life were collected on 139 consecutively admitted adolescents and 111 adults at a residential treatment program (N = 250). The same measures were completed at post-treatment. Group level analyses showed that adults and adolescents improved on all measures analyzed. Only 1.7% of adolescents and 2.3% of adults were below a Body Mass Index of 18.5 at discharge. Positive results across diagnoses and ages are reported for three subscales of the Eating Disorder Inventory-3, with clinical response rates reported. Using clinical responder analyses, it was found that for all individuals struggling with secondary issues, 74.7% were responders on the Beck Depression Inventory-II, 41.0% on the Beck Anxiety Inventory, 63.5% on a measure of quality of life, and 95.8% were responders on the physical subscale and 72.6% on the mental subscale of the SF-36-v2. This study suggests that residential treatment for eating disorders is effective at the group level, and it was effective for the majority of individuals within the group.
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Affiliation(s)
- Michael P Twohig
- a Department of Psychology , Utah State University , Logan , Utah , USA
| | - Ellen J Bluett
- a Department of Psychology , Utah State University , Logan , Utah , USA
| | - Jodi L Cullum
- b School of Medicine, University of Utah , Salt Lake City , Utah , USA
| | - P R Mitchell
- a Department of Psychology , Utah State University , Logan , Utah , USA
| | - Pauline S Powers
- c Department of Psychology , University of South Florida , Tampa , Florida , USA
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Hall A, Ofei-Tenkorang NA, Machan JT, Gordon CM. Use of yoga in outpatient eating disorder treatment: a pilot study. J Eat Disord 2016; 4:38. [PMID: 27980773 PMCID: PMC5148831 DOI: 10.1186/s40337-016-0130-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/05/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Individuals with restrictive eating disorders present with co-morbid psychiatric disorders and many attempt to control symptoms using strenuous exercises that increase caloric expenditure. Yoga offers a safe avenue for the engagement in physical activity while providing an outlet for disease-associated symptoms. This study sought to examine use of yoga practice in an outpatient setting and its impact on anxiety, depression and body image disturbance in adolescents with eating disorders. METHODS Twenty adolescent girls were recruited from an urban eating disorders clinic who participated in weekly yoga classes at a local studio, in addition to standard multidisciplinary care. Yoga instructors underwent training regarding this patient population. Participants completed questionnaires focused on anxiety, depression and body image disturbance prior to the first class, and following completion of 6 and 12 classes. RESULTS In participants who completed the study, a statistically significant decrease in anxiety, depression, and body image disturbance was seen, including: Spielberger State anxiety mean scores decreased after the completion of 7-12 yoga classes [47 (95%CI 42-52) to 42 (95%CI 37-47), adj. p = 0.0316]; as did the anorexia nervosa scale [10 (95% CI 7-12) vs. 6 (95%CI 4-8), adj. p = .0004], scores on Beck depression scales [18 (95%CI 15-22) to 10 (95%CI 6-14), adj. p = .0001], and weight and shape concern scores [16 (95%CI 12-20) to 12 (95%CI 8-16), adj. p =0.0120] and [31 (95%CI 25-37) to 20 (95%CI 13-27), adj. p = 0.0034], respectively. No significant changes in body mass index were seen throughout the trial. CONCLUSIONS Yoga practice combined with outpatient eating disorder treatment were shown to decrease anxiety, depression, and body image disturbance without negatively impacting weight. These preliminary results suggest yoga to be a promising adjunct treatment strategy, along with standard multidisciplinary care. However, whether yoga should be endorsed as a standard component of outpatient eating disorder treatment merits further study.
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Affiliation(s)
- Allison Hall
- Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, RI USA
| | - Nana Ama Ofei-Tenkorang
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH 45229 USA
| | - Jason T Machan
- Department of Orthopaedics & Surgery, Brown University, Providence, RI USA ; Biostatistics Core, Rhode Island Hospital, Providence, RI USA
| | - Catherine M Gordon
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4000, Cincinnati, OH 45229 USA
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Weltzin T, Bean P, Klosterman E, Lee HJ, Welk-Richards R. Sex differences in the effects of residential treatment on the quality of life of eating disorder patients. Eat Weight Disord 2015; 20:301-10. [PMID: 25380978 DOI: 10.1007/s40519-014-0162-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/16/2014] [Indexed: 11/26/2022] Open
Abstract
AIMS This study compared the effects of residential treatment on improving health-related quality of life (HRQOL) between males and females diagnosed with eating disorders (EDs) from admission to discharge and at follow-up. This study also analyzed the association between changes in HRQOL and changes in the severity of ED pathology, depression, and trait anxiety. METHODS 145 consecutive patients (34 males and 111 females) admitted to a residential ED unit completed a panel of surveys at admission and discharge. The survey panel included the Eating Disorders Quality of Life Survey (EDQLS), the Eating Disorder Examination Questionnaire, the Quick Inventory of Depressive Symptomatology and the State-Trait Anxiety Inventory. An online follow-up survey was also conducted for the EDQLS. Mixed-factorial ANOVA was used to examine sex differences and changes in HRQOL between admission, discharge and post-treatment follow-up. Multiple regression analysis was used to investigate the relationship between sex, change in HRQOL, and changes in all other variables studied. RESULTS By the end of residential treatment, both males and females had made similar statistically significant improvements in HRQOL from admission to discharge, which persisted after treatment. Greater decreases in ED pathology and trait anxiety significantly predicted greater increases in HRQOL during residential treatment while sex and changes in depression did not. CONCLUSION The data show that residential treatment is an effective approach to improving HRQOL in both males and females with EDs. Greater improvements in trait anxiety and ED pathology contributed to greater improvement in HRQOL in these patients.
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Affiliation(s)
- Theodore Weltzin
- Eating Disorder Center, Rogers Memorial Hospital, 34700 Valley Road, Oconomowoc, WI, 53066, USA,
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28
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Twohig MP, Bluett EJ, Torgesen JG, Lensegrav-Benson T, Quakenbush-Roberts B. Who seeks residential treatment? A report of patient characteristics, pathology, and functioning in females at a residential treatment facility. Eat Disord 2015; 23:1-14. [PMID: 25298220 DOI: 10.1080/10640266.2014.959845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There has been a growth in the availability and use of residential treatment for eating disorders. Yet there is a paucity of information on the individuals who seek this treatment. This study provides data on 259 consecutive patients (116 adults and 143 adolescents) entering residential treatment for their eating disorders. Upon admission all patients provided individual characteristics data and the following measures: the Eating Disorder Inventory-3 (EDI-3), the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Eating Disorder Quality of Life (EDQOL), and the SF-36 Health Survey-Version 2. Findings are presented by diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified) and age (adult and adolescent). Results show that 61% of adolescents and 80% of adults were above the clinical cutoff for depression, and 59% of adolescents and 78% of adults were above the clinical cutoff for anxiety. Scores on the EDI-3 are presented by subscale and diagnosis. Very low quality of life is reported for both adults and adolescents on the EDQOL. For both adolescents and adults the SF-36 showed average population scores for the physical scale but very low mental scores. Implications for these findings and future directions for this work are discussed.
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Affiliation(s)
- Michel P Twohig
- a Department of Psychology , Utah State University , Logan , Utah , USA
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29
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Madden S, Miskovic-Wheatley J, Wallis A, Kohn M, Lock J, Le Grange D, Jo B, Clarke S, Rhodes P, Hay P, Touyz S. A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med 2015; 45:415-427. [PMID: 25017941 PMCID: PMC4301212 DOI: 10.1017/s0033291714001573] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 05/30/2014] [Accepted: 06/06/2014] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- S. Madden
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
| | - J. Miskovic-Wheatley
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Westmead Clinical School, The University of Sydney, Australia
| | - A. Wallis
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
| | - M. Kohn
- Eating Disorder Service at The Sydney Children's Hospitals Network, Westmead, Australia
- Discipline of Pediatrics, Faculty of Medicine, The University of Sydney, Australia
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - J. Lock
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - D. Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - B. Jo
- Psychiatry and Behavioral Science, School of Medicine, Stanford University, USA
| | - S. Clarke
- Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit, Westmead Hospital, Australia
| | - P. Rhodes
- School of Psychology, The University of Sydney, Australia
| | - P. Hay
- Centre for Health Research, School of Medicine, The University of Western Sydney and School of Medicine, James Cook University, Australia
| | - S. Touyz
- School of Psychology, The University of Sydney, Australia
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Weltzin T, Kay B, Cornella-Carlson T, Timmel P, Klosterman E, Kinnear KA, Welk-Richards R, Lee HJ, Bean P. Long-Term Effects of a Multidisciplinary Residential Treatment Model on Improvements of Symptoms and Weight in Adolescents With Eating Disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/1556035x.2014.868765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Neumark-Sztainer D. Yoga and eating disorders: is there a place for yoga in the prevention and treatment of eating disorders and disordered eating behaviours? ACTA ACUST UNITED AC 2013; 2:136-145. [PMID: 24955291 PMCID: PMC4047628 DOI: 10.1080/21662630.2013.862369] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/27/2013] [Indexed: 12/02/2022]
Abstract
This paper addresses the question: what can the practice of yoga offer the field of eating disorders in terms of prevention and treatment? Regarding prevention, preliminary research suggests that yoga may be effective in decreasing risk factors, and increasing protective factors, for eating disorders. Yoga was also found to be helpful in a small number of treatment studies. However, findings are not consistent across studies, which are limited in number, and due to the preliminary nature of this body of research, most studies have weaknesses in their designs (e.g. observational design, no control groups, or small sample sizes). The basic tenets of yoga, anecdotal reports of its effectiveness, its high accessibility and low cost, and initial research findings suggest that yoga may offer promise for the field of eating disorders. Two options are suggested for prevention: (1) eating disorder prevention can be integrated into ongoing yoga classes and (2) yoga can be integrated into eating disorder prevention programmes. Regarding treatment, it is important to examine the effectiveness of different teaching styles and practices for different eating disorders. Potential harms of yoga should also be explored. Further research, using stronger study designs, such as randomised, controlled trials, is needed.
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Affiliation(s)
- Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Abstract
The high prevalence of substance abuse in individuals with bulimia nervosa (BN) and the pervasive symptom substitution in many types of drug addiction suggest that a number of substances--including food--can impair an individual's self-control, even in the presence of negative consequences. Nonetheless, the neurobiological similarities between BN and drug addiction are not clearly established. This review explores how the specific eating patterns seen in BN (binge eating and purging, with intermittent dietary restriction) are particularly addictive and differentiate BN from other eating disorders and obesity. A number of peripheral and central biological aberrations seen in BN may result in altered reward sensitivity in these individuals, particularly through effects on the dopaminergic system. Neurobiological findings support the notion that BN is an addictive disorder, which has treatment implications for therapy and pharmacological manipulations.
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Lock L, Williams H, Bamford B, Lacey JH. The St George's eating disorders service meal preparation group for inpatients and day patients pursuing full recovery: a pilot study. EUROPEAN EATING DISORDERS REVIEW 2011; 20:218-24. [PMID: 21910164 DOI: 10.1002/erv.1134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 02/18/2011] [Accepted: 04/22/2011] [Indexed: 11/07/2022]
Abstract
This naturalistic cohort study evaluates a meal cookery group-based occupational therapy intervention for adult inpatients and day patients with severe eating disorders. It also evaluates the Eating and Meal Preparation Skills Assessment (EMPSA) as an outcome measure, allowing clients pursuing recovery to rate ability and motivation to perform tasks related to preparing and eating 'normal' meals. Twenty-seven participants completed EMPSAs at their first, 10th and final sessions, plus 1 year later. The Ability subscale of EMPSA indicated significant improvements (p < 0.001) by the 10th session, which was maintained 1 year later. The Motivation subscale of EMPSA indicated no significant changes at the 10th session but highly significant improvements (p < 0.001) between the 10th and final session, which was maintained 1 year later. Internal consistency for EMPSA was demonstrated by Cronbach's alpha of 0.71 for Ability subscale and 0.95 for Motivation subscale. We conclude that the meal preparation group is effective and durable.
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Affiliation(s)
- Laura Lock
- Eating Disorders Service, South West London and St George's Mental Health NHS Trust, Springfield University Hospital, London SW17 7DJ, UK.
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Abstract
We analyzed results from surveys of respondents who had completed ≥ 30 days of treatment at Monte Nido Residential Treatment Program over a 10 year period. Participants with anorexia nervosa (AN; n = 66) and bulimia nervosa (BN; n = 52) completed the Eating Disorders Inventory-2 (EDI-2), the Beck Depression Inventory (BDI), and a structured eating disorder assessment at admission and follow-up. Mean duration between discharge and last follow-up was 4.6 years and 3.8 years for AN and BN respectively. For AN there were significant improvements in BMI, BDI, 10 of 11 EDI-2 subscales, and frequencies of bingeing and purging. For BN there were significant improvements in BDI, all EDI subscales, and frequencies of bingeing and purging. Eighty-nine percent of AN graduates and 75% of BN graduates had good or intermediate outcomes. Using linear regression, the best model contained the single variable, discharge BMI, which predicted 23% of the variance explaining full recovery from AN (p ≤ .02). For BN, the best model contained vomiting frequency and the bulimia subscale score of the EDI-2 at discharge, which accounted for 37% of the variance explaining full recovery from BN (p ≤ .02). The great majority of patients showed significant improvement at long-term follow-up after this program of residential treatment. In addition, these results underscore the importance of weight gain for AN patients and cessation of bulimic symptoms for BN patients when predicting long-term recovery.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
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Greenblatt JM, Sussman C, Jameson M, Yuan L, Hoffman DA, Iosifescu DV. Retrospective chart review of a referenced EEG database in assisting medication selection for treatment of depression in patients with eating disorders. Neuropsychiatr Dis Treat 2011; 7:529-41. [PMID: 21931495 PMCID: PMC3173036 DOI: 10.2147/ndt.s22271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A retrospective chart review was undertaken in a private clinic to examine the clinical outcomes for patients with an eating disorder comorbid with depression or bipolar illness who underwent a referenced electroencephalographic (EEG) database analysis to help guide medication selection. METHOD We examined 33 charts for patients with the primary psychiatric diagnosis of an eating disorder and comorbid major depressive disorder or bipolar disorder who underwent a quantitative EEG database assessment to provide additional information for choices of medication. The current analysis includes data from 22 subjects who accepted treatments based on information from the referenced-EEG medication database. Hamilton Depression Rating Scale, Clinical Global Impression-Severity, Clinical Global Impression-Improvement, and hospitalization data were examined for these patients. RESULTS Patients whose EEG data was used for clinical treatment reported significant decreases in associated depressive symptoms (HDRS scores), overall severity of illness (Clinical Global Impression-Severity), and overall clinical global improvement (Clinical Global Impression- Improvement). This cohort also reported fewer inpatient, residential, and partial hospitalization program days following referenced-EEG compared with the two-year period prior to treatment. CONCLUSION These findings are consistent with previously reported data for patients with eating disorders and suggest the need for future studies using EEG data correlated with those from other patients with similar quantitative EEG features.
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Delinsky SS, St Germain SA, Thomas JJ, Craigen KE, Fagley WH, Weigel TJ, Levendusky P, Becker AE. Naturalistic study of course, effectiveness, and predictors of outcome among female adolescents in residential treatment for eating disorders. Eat Weight Disord 2010; 15:e127-35. [PMID: 21150248 DOI: 10.1007/bf03325292] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Few empirical data address naturalistic outcomes of residential eating disorder (ED) treatment. Study aims were to evaluate course, effectiveness, and predictors of outcome in a residential treatment program. We evaluated 80 consecutively admitted female adolescents with the SCID-IV. Primary outcomes were treatment completion, subsequent readmission, clinical global impressions, and changes in body weight. Mean length of stay was 51 days, and 80% of patients were discharged according to treatment plans. Mean expected body weight (EBW) for AN patients increased from 80% to 91%. Patients reported significant improvements in ED symptoms, depression, and quality of life. Low admission %EBW and previous psychiatric hospitalizations were associated with premature termination. Overall, findings support that residential treatment is largely acceptable to patients, and that residential care may provide an opportunity for substantive therapeutic gains.
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Affiliation(s)
- S S Delinsky
- Klarman Eating Disorders Center, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA.
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Herpertz-Dahlmann B, Salbach-Andrae H. Overview of treatment modalities in adolescent anorexia nervosa. Child Adolesc Psychiatr Clin N Am 2009; 18:131-45. [PMID: 19014862 DOI: 10.1016/j.chc.2008.07.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Departments of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
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Bean P, Welk R, Hallinan P, Cornella-Carlson T, Weisensel N, Weltzin T. The Effects of a Multidisciplinary Approach to Treatment in the Recovery of Males and Females Diagnosed with Anorexia Nervosa in the Presence and Absence of Co-Morbid Obsessive Compulsive Disorders. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/15560350802424969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Pamela Bean
- a Rogers Memorial Hospital , Oconomowoc , WI
| | - Robyn Welk
- b Eating Disorder Center , Rogers Memorial Hospital , Oconomowoc , WI
| | | | | | | | - Theodore Weltzin
- b Eating Disorder Center , Rogers Memorial Hospital , Oconomowoc , WI
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Schaffner AD, Buchanan LP. Integrating evidence-based treatments with individual needs in an outpatient facility for eating disorders. Eat Disord 2008; 16:378-92. [PMID: 18821362 DOI: 10.1080/10640260802370549] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to evaluate the effectiveness of a day treatment program for 77 women diagnosed with eating disorders. The program utilizes an integrative approach, combining evidence-based treatments such as cognitive-behavioral therapy with clinical experience and additional multimodal interventions based on individual needs. Three modes of treatment used in the program (group therapy, family therapy, and individual therapy) and two levels of treatment (partial hospitalization and intensive outpatient) are described in detail. The effectiveness of the treatment program was evaluated by comparing pre-treatment and post-treatment data on outcome measures for eating disorder attitudes, personality characteristics, and symptoms, as well as depressive symptoms and anxiety symptoms. Results indicated that after an average of 12.8 weeks of treatment, patients reported a significant reduction in eating disorder symptoms, depressive symptoms, and anxiety symptoms, and a significant increase in weight at post-treatment. Implications of these findings and directions for future research are discussed.
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40
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McHugh MD. Readiness for change and short-term outcomes of female adolescents in residential treatment for anorexia nervosa. Int J Eat Disord 2007; 40:602-12. [PMID: 17610253 DOI: 10.1002/eat.20425] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine if readiness for change (RFC) at admission predicted length of stay (LOS) and short-term outcomes among female adolescents in residential treatment for anorexia nervosa (AN). METHOD Using a prospective cohort design to collect data from participants (N = 65) at admission and discharge, Kaplan-Meier survival analysis and Cox regression tested whether RFC on admission predicted time in LOS to a favorable short-term outcome--a composite endpoint based on minimum criteria for weight gain, drive for thinness, depression, anxiety, and health-related quality of life (HRQOL). RESULTS Participants with low RFC had a mean survival time to a favorable short-term outcome of 59.4 days compared to 34.1 days for those with high RFC (log rank = 8.44, df = 1, p = .003). The probability of a favorable short-term outcome was 5.30 times greater for participants with high RFC. CONCLUSION Readiness for change is a useful predictor of a favorable short-term outcome and should be considered in the assessment profile of patients with AN.
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Affiliation(s)
- Matthew D McHugh
- The Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104, USA.
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Abstract
Arts-based therapies are increasingly being employed, in conjunction with empirically valid traditional therapies, in the residential treatment of eating disorders. A systematic database search of arts-based therapies in the treatment of eating disorders was conducted. In addition, program staff at 22 residential eating disorder treatment programs were contacted to provide information regarding arts-based therapy utilization rates. Of the 19 programs that participated in this study, all incorporate arts-based therapies on at least a weekly basis in the treatment of eating disorders. However, while published narrative reflections on arts-based therapies and eating disorders imply a generally positive outcome, no known, empirically valid studies exist on this experiential form of therapy within the area of eating disorders.
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Abstract
The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The alpha coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.
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Affiliation(s)
- Z Cooper
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital
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