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Nielsen S, Vilmar JW. What can we learn about eating disorder mortality from eating disorder diagnoses at initial assessment? A Danish nationwide register follow-up study using record linkage, encompassing 45 years (1970-2014). Psychiatry Res 2021; 303:114091. [PMID: 34246009 DOI: 10.1016/j.psychres.2021.114091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 06/11/2021] [Accepted: 06/27/2021] [Indexed: 12/14/2022]
Abstract
Increased risk for premature mortality is well established for women and girls diagnosed with anorexia nervosa (AN), but less is known for other types of eating disorder (ED), and especially the mortality outcome for boys and men is under-studied. In this registry-based observational epidemiological study, we included all people appearing in the Danish Psychiatric Central Research Register with an eating disorder (ED) diagnosis in the time period from Jan 1,1970 to Dec 31, 2014 (N: 22,633). For each patient four controls without ED were selected, matched for age, sex and place of residence (N: 90486). In all 802 people with ED died over 255762.6 person-years of observation. Standardized mortality ratio (SMR) for all-cause mortality and suicide mortality was significantly increased for all ED-diagnoses in women. The SMRs for men were similar, but only reached significance for the diagnoses AN and unspecified ED. Mortality by natural causes and accidents was significantly increased in most ED-diagnoses in women. The unequal female-to-male ratio in this, and most other studies of ED-patients, suggests that boys and men with ED have unmet needs.
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2
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Prasad KE, Rajan RJ, Basker MM, Mammen PM, Reshmi YS. Clinical Profile of Adolescent Onset Anorexia Nervosa at a Tertiary Care Center. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Guinhut M, Godart N, Benadjaoud MA, Melchior JC, Hanachi M. Five-year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a medical unit. Acta Psychiatr Scand 2021; 143:130-140. [PMID: 33247947 DOI: 10.1111/acps.13261] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with one of the highest mortality rates of any psychiatric disorder but limited mortality data were reported for those with extremely severe malnutrition. This study aimed to estimate standardized mortality ratio (SMR), investigate predictive factors of mortality and causes of death among a sample of patients with AN admitted to a specialized clinical nutrition unit (CNU) because of extremely severe malnutrition. METHODS Between 11/27/1997 and 01/15/2014, vital status was determined for 384 patients admitted for AN at the first time in the CNU. Sociodemographic, anamnestic, and clinical data were collected. We calculated the SMR. Univariate and multivariate Cox regression analyses were performed to identify mortality predictors. RESULTS Crude mortality rate was 11.5%. (44 deaths) and SMR 15.9 [CI 95% (11.6-21.4)], 5.2 years post inpatient treatment. Mortality predictors at the time of hospitalization were as follows: older age, occurrence of an in-hospital suicide attempt, transfer to medical intensive care unit and the following somatic complications: frank anemia, dysnatremia, infectious and cardiac complications. Other predictors of mortality were: past or present history of discharge against medical advice, hematological comorbidities (not related to AN). A longer inpatient length of stay was a protective factor. CONCLUSION Very severely malnourished patients with AN hospitalized in a medical unit because of extremely severe somatic issues have a medium-term mortality rate higher than the general population and even higher than patients in tertiary specialized ED units. This study highlights predictive factors of mortality that will help clinicians in recognizing and managing patients at risk of death.
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Affiliation(s)
| | - Nathalie Godart
- Fondation Santé des Etudiants de France, Paris, France.,CESP, INSERM, UMR 1018, Paris-Saclay University, Paris, France
| | | | - Jean-Claude Melchior
- Clinical Nutrition Unit, Paul Brousse Hospital, APHP, Villejuif, France.,Paris-Saclay University, France
| | - Mouna Hanachi
- Clinical Nutrition Unit, Paul Brousse Hospital, APHP, Villejuif, France.,Paris-Saclay University, France.,UMR Micalis Institut, INRA, Jouy-En-Josas, France
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4
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Devoe DJ, Anderson A, Bahji A, Singh M, Patten SB, Soumbasis A, Ramirez Pineda A, Flanagan J, Richardson C, Lange T, Dimitropoulos G, Paslakis G. The Prevalence of Impulse Control Disorders and Behavioral Addictions in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:724034. [PMID: 35069274 PMCID: PMC8770943 DOI: 10.3389/fpsyt.2021.724034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: Individuals with eating disorders (EDs) may present with impulse control disorders (ICDs) and behavioral addictions (BAs), which may result in additional suffering and treatment resistance. However, the prevalence of ICDs and BAs in EDs has not been systematically examined. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of ICDs and BAs in ED samples. Methods: A comprehensive electronic database search of the peer-reviewed literature was conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from their inception to May 2021. We restricted review eligibility to research studies reporting prevalence for ICDs or BAs in individuals with diagnosed EDs. The outcome for this review was the prevalence of ICDs or BAs in individuals with EDs. A series of random-effects meta-analyses were performed on eligible studies to estimate the pooled proportions and 95% confidence intervals (CIs). Results: Thirty-five studies met the inclusion criteria, including a total of 9,646 individuals identified as having an ED, 18 of these studies specifically examined ICDs/BAs in AN, BN, and BED. Random-effects pooled estimates demonstrated that the comorbid prevalence of any ICD was 22%. The prevalence of comorbid pathological/compulsive buying was highest (19%), followed by kleptomania (18%), pathological internet use (12%), intermittent explosive disorder (4%), trichotillomania (3%), and gambling disorder (2%). In addition, the prevalence of stealing/shoplifting behaviors was 30% in those with EDs. Conclusion: This is the first meta-analysis on the comorbid prevalence of EDs and ICDs/BAs. We found a moderate prevalence for these comorbid conditions, with approximately one out of five individuals with an ED also displaying a comorbid ICD/BA. Although causal inferences cannot be drawn, the numbers strongly suggest that clinical screening/monitoring of ICDs/BAs should be part of the clinical routine in cohorts with EDs. ED settings need either the capacity to manage these disorders or adequate access to relevant services. Further investigations are needed to reveal common underlying pathomechanisms. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202044.
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Affiliation(s)
- Daniel J Devoe
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alida Anderson
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anees Bahji
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Manya Singh
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Andrea Soumbasis
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Ana Ramirez Pineda
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jordyn Flanagan
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Tom Lange
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Lübbecke, Germany
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5
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Di Lodovico L, Duquesnoy M, Dicembre M, Ringuenet D, Godart N, Gorwood P, Melchior JC, Hanachi M. What distinguish patients with compulsory treatment for severely undernourished anorexia nervosa. Eur Eat Disord Rev 2020; 29:144-151. [PMID: 32865866 DOI: 10.1002/erv.2790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a mental disorder potentially leading to severe malnutrition and life-threatening complications, with high mortality rates and dropouts from treatment. In the most severe cases, treatment refusal associated with acute nutritional disorders may require compulsory admission in specialised units. The aim of this study was to investigate clinical and nutritional parameters associated with the use of compulsory treatment for severely ill AN patients requiring intensive nutritional care. METHODS This retrospective, single-centre study performed in a unit of specialised nutritional care compared severely undernourished inpatients, compulsorily admitted for AN, with a population of sex- and age-matched voluntarily admitted patients. Socio-demographic and clinical variables were collected for univariate comparison and logistic regression. RESULTS Compulsory treatment in AN was mainly associated with lower socio-economic status (p < 0.01), history of lower weight (p < 0.05), more frequently prescribed psychotropic medication (p = 0.02), more previous admissions for AN, longer hospitalisations (p < 0.01) and binge eating/purging subtype (p = 0.02). Binge eating/purging subtype and the number of past admissions showed the strongest odds of compulsory treatment in multivariate analysis. CONCLUSION The knowledge of factors associated with compulsory treatment may help practitioners of all fields to better evaluate its pertinence and indications in AN.
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Affiliation(s)
- Laura Di Lodovico
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Maeva Duquesnoy
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.,Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Marika Dicembre
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Damien Ringuenet
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.,Eating Disorder Unit, Department of Psychiatry, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | | | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France.,Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Jean-Claude Melchior
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.,Paris-Saclay University, Le Kremlin-Bicêtre, France.,Eating Disorder Unit, Department of Psychiatry, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Mouna Hanachi
- Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.,Paris-Saclay University, Le Kremlin-Bicêtre, France.,Institut Micalis, INRA, AgroParisTech, Université Paris-Saclay, Jouy en Josas, France
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6
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Liu W, Zhan S, Li D, Lin Z, Zhang C, Wang T, Pan S, Zhang J, Cao C, Jin H, Li Y, Sun B. Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study. Brain Stimul 2020; 13:643-649. [PMID: 32289691 DOI: 10.1016/j.brs.2020.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Given that anorexia nervosa (AN) is a life-threatening mental disorder and has poor clinical outcomes, novel effective treatments are warranted, especially for severe and persistent cases. OBJECTIVE To investigate the safety, feasibility, and clinical outcomes of using deep brain stimulation (DBS) of the nucleus accumbens (NAcc) in treatment-refractory AN patients. METHODS A total of 28 women with refractory AN underwent NAcc-DBS and completed this 2-year follow-up study. The clinical outcomes, including body mass index (BMI) and mood, anxiety, and obsessive symptoms, were assessed using a series of psychiatric scales at 6 and 24 months post operation. RESULTS While no fatalities were reported during this study, 1 patient showed device rejection. The most common short-term side effect observed was varying degrees of pain at the incision sites (n = 22), which usually disappeared 3-4 days following the operation. No severe surgical adverse events were observed. Compared to presurgical levels, significant increases in BMI and improvement in psychiatric scale scores were noted during the 6-month follow-up and were maintained at the 2-year review. Finally, a post-hoc analysis revealed that the NAcc-DBS was less effective for weight restoration in patients with the binge-eating/purge subtype of AN than in those with the restricting subtype (R-AN). CONCLUSION Our long-term follow-up study suggests that NAcc-DBS is safe and effective for improving the BMI and psychiatric symptoms of patients with refractory AN. Although NAcc-DBS appears to be more suitable for patients with R-AN, strict inclusion criteria must be applied considering surgery-related complications.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sijian Pan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Cao
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Shanghai YangPu District Mental Health Center, Shanghai, China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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7
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Kanayama S, Sakai C, Aoto H, Endo Y, Minamimae K, Katayama T, Nagaishi JI, Hanaki K. Childhood dietary intake: Comparison between anorexia nervosa and healthy leanness. Pediatr Int 2019; 61:73-79. [PMID: 30402965 DOI: 10.1111/ped.13730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of adolescent patients with anorexia nervosa is increasing. In addition, an increase in pre-adolescent patients with premenarchal onset has also been recognized. Detection of the disease in childhood and adolescence, however, is not always easy because the symptoms are not characteristic during this period. This study was performed to investigate detection of anorexia nervosa in children/adolescents by comparing energy and nutrient intake between patients with anorexia nervosa and healthy thin persons. METHODS The subjects consisted of 13 girls aged 14.4 ± 3.5 years with anorexia nervosa and 320 healthy girls aged 12.4 ± 1.3 years. Dietary intake was evaluated using a validated diet history questionnaire designed for children/adolescents. Daily energy and nutrient intake were expressed as a percentage of the age- and sex-matched reference amount. RESULTS Healthy lean (body mass index [BMI], <50th percentile) girls with an above-average score for desiring thinness had higher fat and lower cereal intake, and a trend of lower carbohydrate intake. In contrast, patients with anorexia nervosa, compared with thin (BMI <5th percentile) girls, characteristically had significantly lower energy, fat, zinc, vitamin C, and confectionery intake. CONCLUSIONS Lean girls with an above-average desire for thinness appear to restrict their energy intake by reducing their intake of carbohydrates such as cereals while maintaining a relatively high fat intake. In contrast, girls with anorexia nervosa avoided fat and had a preference for vegetables. This characteristic eating pattern could be a useful clue for detection of anorexia nervosa in thin children and adolescents.
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Affiliation(s)
- Shunsuke Kanayama
- School of Health Sciences, Tottori University, Yonago, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Tottori University, Yonago, Japan.,Department of Nursing, The University of Shimane, Izumo, Japan
| | - Chieko Sakai
- School of Health Sciences, Tottori University, Yonago, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Tottori University, Yonago, Japan
| | - Haruka Aoto
- School of Health Sciences, Tottori University, Yonago, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Tottori University, Yonago, Japan
| | - Yuri Endo
- School of Health Sciences, Tottori University, Yonago, Japan
| | - Keiko Minamimae
- School of Health Sciences, Tottori University, Yonago, Japan
| | - Takeshi Katayama
- Department of Pediatrics, Tsuyama Chuo Hospital, Kawasaki, Tsuyama, Japan
| | - Jun-Ichi Nagaishi
- Department of Pediatrics, Tottori Municipal Hospital, Matoba, Tottori, Japan
| | - Keiichi Hanaki
- School of Health Sciences, Tottori University, Yonago, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Tottori University, Yonago, Japan
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8
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Maguire S, Surgenor LJ, Le Grange D, Lacey H, Crosby RD, Engel SG, Fromholtz KM, Bamford B, Touyz S. Examining a staging model for anorexia nervosa: empirical exploration of a four stage model of severity. J Eat Disord 2017; 5:41. [PMID: 29209500 PMCID: PMC5702958 DOI: 10.1186/s40337-017-0155-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 05/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An illness staging model for anorexia nervosa (AN) has received increasing attention, but assessing the merits of this concept is dependent on empirically examining a model in clinical samples. Building on preliminary findings regarding the reliability and validity of the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN), the current study explores operationalising CASIAN severity scores into stages and assesses their relationship with other clinical features. METHOD In women with DSM-IV-R AN and sub-threshold AN (all met AN criteria using DSM 5), receiver operating curve (ROC) analysis (n = 67) assessed the relationship between the sensitivity and specificity of each stage of the CASIAN. Thereafter chi-square and post-hoc adjusted residual analysis provided a preliminary assessment of the validity of the stages comparing the relationship between stage and treatment intensity and AN sub-types, and explored movement between stages after six months (Time 3) in a larger cohort (n = 171). RESULTS The CASIAN significantly distinguished between milder stages of illness (Stage 1 and 2) versus more severe stages of illness (Stages 3 and 4), and approached statistical significance in distinguishing each of the four stages from one other. CASIAN Stages were significantly associated with treatment modality and primary diagnosis, and CASIAN Stage at Time 1 was significantly associated with Stage at 6 month follow-up. CONCLUSIONS Provisional support is provided for a staging model in AN. Larger studies with longer follow-up of cases are now needed to replicate and extend these findings and evaluate the overall utility of staging as well as optimal staging models.
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Affiliation(s)
- Sarah Maguire
- Centre for Eating and Dieting Disorders, University of Sydney, Sydney, Australia
| | - Lois J Surgenor
- Department of Psychological Medicine, University of Otago at Christchurch, Christchurch, New Zealand
| | - Daniel Le Grange
- Department of Psychiatry, University of California, Christchurch, USA
| | - Hubert Lacey
- St Georges University of London, Eating Disorders Research Group, London, UK
| | - Ross D Crosby
- Neuropsychiatric Research Institute, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota USA
| | - Kirsty M Fromholtz
- Centre for Eating and Dieting Disorders, University of Sydney, Sydney, Australia
| | - Bryony Bamford
- The London Centre for Eating Disorders and Body Image, London, UK
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
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9
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Davies JE, Cockfield A, Brown A, Corr J, Smith D, Munro C. The medical risks of severe anorexia nervosa during initial re-feeding and medical stabilisation. Clin Nutr ESPEN 2017; 17:92-9. [PMID: 28361754 DOI: 10.1016/j.clnesp.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 09/02/2016] [Accepted: 09/27/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Objective evidence about the risks associated with anorexia nervosa and how to manage them, is limited. The aim of this study is to describe the medical risk profile, management and outcomes of a cohort of patients with severe anorexia nervosa (sAN) during medical stabilisation treatment. METHODS Retrospective analysis of case records gathered medical risk data for a 90 day high risk period, on 65 patients with sAN admitted to two specialist services. Prospectively established definitions of medical risk variables and significant complications were applied to the data to describe the risk profiles and outcomes. RESULTS Amongst this population with an average initial BMI of 12.8 kg/m2, 74% developed no significant medical complications. Oral re-feeding over 60 days achieved an increase in mean BMI to 14.4 kg/m2 and mean weight gain of 4 kg. No patients developed severe hypophosphatemia (<0.45 mmol/L) or any other indicators of a re-feeding syndrome. All the medical complications that arose were temporary. CONCLUSIONS Initial re-feeding and medical stabilisation of patients with severe AN can be managed safely in specialist inpatient and community settings with slow re-feeding. Although the prevalence of complications was shown to be low, slight worsening of medical risk markers and increased incidence of complications did occur during initial re-feeding. The limited comparable published data appears to support slower rates of re-feeding, showing fewer abnormal results and complications. There is however a need for a definitive prospective multi-centre observational cohort study to investigate risks factors, and the effects of treatment on medical outcomes, in a large sample with varied rates of re-feeding.
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10
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Kells M, Schubert-Bob P, Nagle K, Hitchko L, O'Neil K, Forbes P, McCabe M. Meal Supervision During Medical Hospitalization for Eating Disorders. Clin Nurs Res 2016; 26:525-537. [PMID: 26964805 DOI: 10.1177/1054773816637598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The focus of medical hospitalization for restrictive eating disorders is weight gain; however, no guidelines exist on how to achieve successful and safe weight gain. Meal supervision may be a supportive intervention to aid in meal completion and weight gain. The aim of this study was to examine the effect of standardized meal supervision on weight gain, length of stay, vital signs, electrolytes, and use of liquid caloric supplementation in hospitalized adolescents and young adults with restrictive eating disorders. A chart review compared patients who received meal supervision from admission through discharge to an earlier cohort who received meal supervision as needed. There were no differences in weight, electrolytes, or vital signs between the two cohorts. Length of stay for those who received meal supervision from admission was 3 days shorter than earlier cohort. Nursing supervised meals beginning at admission may shorten length of stay and decrease health care costs.
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Affiliation(s)
| | | | | | | | - Kathleen O'Neil
- 1 Boston Children's Hospital, MA, USA.,2 Mid-Pacific Institute, Honolulu, HI, USA
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11
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ITO HIROYUKI, MURAYAMA YASUO, KATAGIRI MASATOSHI, NAKAJIMA SYUNJI, HAMADA MEGUMI, TANAKA YOSHIHIRO, NODA WATARU, TAKAYANAGI NOBUYA, TSUJII MASATSUGU. Abnormal Eating Behavior in Elementary and Junior High School Students : Relation to Mental Health and Social Maladjustment. ACTA ACUST UNITED AC 2016. [DOI: 10.5926/jjep.64.170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Goldberg S, Werbeloff N, Shelef L, Fruchter E, Weiser M. Risk of suicide among female adolescents with eating disorders: a longitudinal population-based study. Eat Weight Disord 2015; 20:295-300. [PMID: 25596926 DOI: 10.1007/s40519-015-0176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Suicide is a major cause of death among individuals with eating disorders. This study examined risk of suicide among females with eating disorders based on population-based military data. METHODS Data on diagnoses of eating disorders from the pre-induction screening for psychopathology and diagnoses assigned during military service were merged with data on later suicide from the nationwide Israeli Death Registry. We identified 1,356 females with eating disorders and compared their risk of suicide to a population-based control group of females without eating disorders over a mean follow-up period of 8.5 ± 5.34 years. RESULTS Females with eating disorders had a higher rate of suicide (0.22 %, n = 3) compared to females without eating disorders (0.03 %, n = 166). Having a moderate-severe eating disorder was associated with increased risk of suicide (RR = 12.50, 95 % CI = 3.86-38.09), whereas none of the females diagnosed as having a mild eating disorder died by suicide. CONCLUSIONS Females with moderate-severe eating disorders are at risk of suicide and should be monitored for suicidal intent.
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Keshaviah A, Edkins K, Hastings ER, Krishna M, Franko DL, Herzog DB, Thomas JJ, Murray HB, Eddy KT. Re-examining premature mortality in anorexia nervosa: a meta-analysis redux. Compr Psychiatry 2014; 55:1773-84. [PMID: 25214371 DOI: 10.1016/j.comppsych.2014.07.017] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022] Open
Abstract
Anorexia nervosa (AN) is reported to have the highest premature mortality of any psychiatric disorder, but recent meta-analyses may have inflated estimates. We sought to re-estimate mortality after methodological corrections and to identify predictors of mortality. We included 41 cohorts from 40 peer-reviewed studies published between 1966 and 2010. Methods included double data extraction, log-linear regression with an over-dispersed Poisson model, and all-cause and suicide-specific standardized mortality ratios (SMRs), with 95% Poisson confidence intervals. Participants with AN were 5.2 [3.7-7.5] times more likely to die prematurely from any cause, and 18.1 [11.5-28.7] times more likely to die by suicide than 15-34 year old females in the general population. Our estimates were 10% and 49% lower, respectively, than previously reported SMRs. Risk of premature mortality was highest in studies with older participants, although confounding by treatment was present. Gender, ascertainment, and diagnostic criteria also impacted risk.
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Affiliation(s)
- Aparna Keshaviah
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Edkins
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth R Hastings
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; The Amundsen Group, Burlington, MA, USA
| | - Meera Krishna
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Northeastern University, Boston, MA, USA
| | - David B Herzog
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Helen B Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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Munro C, Thomson V, Corr J, Randell L, Davies JE, Gittoes C, Honeyman V, Freeman CP. A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team. Psychiatr Bull (2014) 2014; 38:220-5. [PMID: 25285220 PMCID: PMC4180986 DOI: 10.1192/pb.bp.113.044818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 11/23/2022]
Abstract
Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.
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Affiliation(s)
- Calum Munro
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK ; Department of Psychiatry, University of Edinburgh, UK
| | - Victoria Thomson
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Jean Corr
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Louise Randell
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Jennie E Davies
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Claire Gittoes
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Vicky Honeyman
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK
| | - Chris P Freeman
- Anorexia Nervosa Intensive Treatment Team (ANITT), NHS Lothian, Edinburgh, UK ; Queen Margaret University, Edinburgh, UK
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Nakai Y, Nin K, Noma S, Hamagaki S, Takagi R, Wonderlich SA. Outcome of Eating Disorders in a Japanese Sample: A 4- to 9-year Follow-up Study. Eur Eat Disorders Rev 2014; 22:206-11. [DOI: 10.1002/erv.2290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 02/14/2014] [Accepted: 02/25/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | - Kazuko Nin
- School of Health Sciences, Faculty of Medicine; Kyoto University; Kyoto Japan
| | - Shun'ichi Noma
- Department of Psychiatry, School of Medicine; Kyoto University; Kyoto Japan
| | | | | | - Stephen A. Wonderlich
- Department of Clinical Neuroscience, School of Medicine & Health Sciences; University of North Dakota; Fargo ND USA
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Morris J, Simpson AV, Voy SJ. Length of Stay of Inpatients with Eating Disorders. Clin Psychol Psychother 2013; 22:45-53. [DOI: 10.1002/cpp.1865] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/28/2013] [Accepted: 07/29/2013] [Indexed: 11/05/2022]
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Kells M, Davidson K, Hitchko L, O'Neil K, Schubert-Bob P, McCabe M. Examining supervised meals in patients with restrictive eating disorders. Appl Nurs Res 2013; 26:76-9. [DOI: 10.1016/j.apnr.2012.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 06/05/2012] [Accepted: 06/18/2012] [Indexed: 12/20/2022]
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Lipsman N, Woodside DB, Giacobbe P, Hamani C, Carter JC, Norwood SJ, Sutandar K, Staab R, Elias G, Lyman CH, Smith GS, Lozano AM. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet 2013; 381:1361-1370. [PMID: 23473846 DOI: 10.1016/s0140-6736(12)62188-6] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anorexia nervosa is characterised by a chronic course that is refractory to treatment in many patients and has one of the highest mortality rates of any psychiatric disorder. Deep brain stimulation (DBS) has been applied to circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. We aimed to assess the safety of DBS to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa. METHODS We did a phase 1, prospective trial of subcallosal cingulate DBS in six patients with chronic, severe, and treatment-refractory anorexia nervosa. Eligible patients were aged 20-60 years, had been diagnosed with restricting or binge-purging anorexia nervosa, and showed evidence of chronicity or treatment resistance. Patients underwent medical optimisation preoperatively and had baseline body-mass index (BMI), psychometric, and neuroimaging investigations, followed by implantation of electrodes and pulse generators for continuous delivery of electrical stimulation. Patients were followed up for 9 months after DBS activation, and the primary outcome of adverse events associated with surgery or stimulation was monitored at every follow-up visit. Repeat psychometric assessments, BMI measurements, and neuroimaging investigations were also done at various intervals. This trial is registered with ClinicalTrials.gov, number NCT01476540. FINDINGS DBS was associated with several adverse events, only one of which (seizure during programming, roughly 2 weeks after surgery) was serious. Other related adverse events were panic attack during surgery, nausea, air embolus, and pain. After 9 months, three of the six patients had achieved and maintained a BMI greater than their historical baselines. DBS was associated with improvements in mood, anxiety, affective regulation, and anorexia nervosa-related obsessions and compulsions in four patients and with improvements in quality of life in three patients after 6 months of stimulation. These clinical benefits were accompanied by changes in cerebral glucose metabolism (seen in a comparison of composite PET scans at baseline and 6 months) that were consistent with a reversal of the abnormalities seen in the anterior cingulate, insula, and parietal lobe in the disorder. INTERPRETATION Subcallosal cingulate DBS seems to be generally safe in this sample of patients with chronic and treatment-refractory anorexia nervosa. FUNDING Klarman Family Foundation Grants Program in Eating Disorders Research and Canadian Institutes of Health Research.
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Affiliation(s)
- Nir Lipsman
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Clement Hamani
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jacqueline C Carter
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | | | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, Toronto General Hospital, ON, Canada
| | - Randy Staab
- Division of Psychiatry, Credit Valley Hospital, Mississauga, ON, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher H Lyman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gwenn S Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Gueguen J, Godart N, Chambry J, Brun-Eberentz A, Foulon C, Divac Phd SM, Guelfi JD, Rouillon F, Falissard B, Huas C. Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord 2012; 45:537-45. [PMID: 22271620 DOI: 10.1002/eat.20987] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare clinical characteristics of men and women with severe AN and to analyze mortality in men. METHOD One thousand and nine patients including 23 anorectic males were hospitalized in St. Anne Hospital in Paris between 1988 and 2004. Data were collected during hospitalization. Fatal outcome was assessed in 2008. RESULTS Men presented significantly later age of onset, were more likely to have a history of premorbid overweight than women and less likely to have attempted suicide. Mortality in men was high (standardized mortality ratio: 8.08; 95% CI: 1.62-23.62). Several predictive factors for mortality in men were identified: lower admission body mass index (BMI), later age at admission, and AN-R subtype. All the three deceased patients had dropped out from the inpatient unit. The 10-year survival did not differ between men and women, but men died sooner after hospitalization. DISCUSSION Male inpatients should receive close follow-up after their discharge, especially if they have a restrictive form of AN, present low BMI, or are older at admission.
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Maguire S, Touyz S, Surgenor L, Crosby RD, Engel SG, Lacey H, Heywood-Everett S, Le Grange D. The clinician administered staging instrument for anorexia nervosa: development and psychometric properties. Int J Eat Disord 2012; 45:390-9. [PMID: 22407867 PMCID: PMC8674751 DOI: 10.1002/eat.20951] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop and evaluate an instrument to assess severity in anorexia nervosa (AN), the Clinician Administered Staging Instrument for Anorexia Nervosa (CASIAN). METHOD Candidate items for the CASIAN were developed in three phases (domain, content, and item generation) followed by a pilot study. The psychometric properties of the resultant 34-item questionnaire were investigated in cross-sectional and longitudinal samples (N = 171) with DSM-IV AN and subthreshold AN. RESULTS Item and factor analysis procedures resulted in a refined 23-item CASIAN comprising of six factors ("Motivation," "Weight," "Illness Duration," "Obsessionality," "Bulimic Behaviors," and "Acute Issues"). The CASIAN had high internal consistency (.811), test-retest (.957), and interrater reliability (.973). Preliminary support for the convergent, discriminant, concurrent, and predictive validity of the CASIAN was found. DISCUSSION The CASIAN is a psychometrically sound instrument. Further studies are needed to confirm the factor structure and assess its clinical and research utility.
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Affiliation(s)
- Sarah Maguire
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Lois Surgenor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Scott G. Engel
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Hubert Lacey
- St Georges School of Medicine, University of London, London, United Kingdom
| | - Suzanne Heywood-Everett
- Division of Psychology, Yorkshire Centre for Eating Disorders, Leeds, United Kingdom,Bradford District Care Trust, Bradford, United Kingdom
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois
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Amemiya N, Takii M, Hata T, Morita C, Takakura S, Oshikiri K, Urabe H, Tokunaga S, Nozaki T, Kawai K, Sudo N, Kubo C. The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit. Eat Weight Disord 2012; 17:e1-8. [PMID: 21997338 DOI: 10.3275/8034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the outcome of Japanese anorexia nervosa (AN) patients who were treated with the standard Japanese inpatient therapy. METHOD Of the 88 female AN patients treated with our inpatient therapy between January 1997 and December 2002, 67 (76.1%) who agreed to cooperate in this study were assessed by the Global Clinical Score (GCS) at admission and follow-up, 6.3±1.8 years after discharge. Their clinical characteristics at admission and discharge were also examined. RESULTS Four (6.0%) patients had died before follow-up. BMI was significantly increased during inpatient therapy. At follow-up, excellent, much improved, symptomatic, and poor outcomes on GCS were 57.1%, 14.3%, 14.3% and 14.3%, respectively. Younger age at admission and larger BMI at discharge were significantly associated with a better outcome. DISCUSSION This study shows the potential for the use of this method for the treatment of AN patients in countries without specialized eating disorder units.
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Affiliation(s)
- N Amemiya
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. ACTA ACUST UNITED AC 2011; 68:724-31. [PMID: 21727255 DOI: 10.1001/archgenpsychiatry.2011.74] [Citation(s) in RCA: 1443] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified. OBJECTIVE To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). DATA SOURCES A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience). STUDY SELECTION English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders. DATA EXTRACTION Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis. DATA SYNTHESIS From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide. CONCLUSIONS Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.
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Affiliation(s)
- Jon Arcelus
- Loughborough University Centre for Research into Eating Disorders, Loughborough University England.
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Rigaud D, Pennacchio H, Bizeul C, Reveillard V, Vergès B. Outcome in AN adult patients: A 13-year follow-up in 484 patients. Diabetes & Metabolism 2011; 37:305-11. [DOI: 10.1016/j.diabet.2010.11.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 10/27/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE Past meta-analyses on suicide in eating disorders included few available studies. METHOD PubMed/Medline search for papers including sample n ≥40 and follow-up ≥5 years: 40 studies on anorexia nervosa (AN), 16 studies on bulimia nervosa (BN), and three studies on binge eating disorder (BED) were included. RESULTS Of 16,342 patients with AN, 245 suicides occurred over a mean follow-up of 11.1 years (suicide rate=0.124 per 100 person-years). Standardized mortality ratio (SMR) was 31.0 (Poisson 95% CI=21.0-44.0); a clear decrease in suicide risk over time was observed in recent decades. Of 1768 patients with BN, four suicides occurred over a mean follow-up of 7.5 years (suicide rate=0.030 per 100 person-years): SMR was 7.5 (1.6-11.6). No suicide occurred among 246 patients with BED (mean follow-up=5.3 years). CONCLUSION AN and BN share many risk factors for suicide: the factors causing lower suicide rates per person-year in BN compared to AN should be investigated.
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Affiliation(s)
- A Preti
- Centro Medico Genneruxi, Via Costantinopoli 42, Cagliari, Italy.
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Huas C, Caille A, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B. Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatr Scand 2011; 123:62-70. [PMID: 20958272 DOI: 10.1111/j.1600-0447.2010.01627.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Little is known concerning mortality and predictive factors for anorexia nervosa in-patients. This study aimed to establish mortality rates and identify predictors in a large sample of adults through a 10-year post in-patient treatment follow-up. METHOD Vital status was established for 601 anorexia nervosa (DSM-IV) consecutive in-patients with initial evaluation at admission. Standardized mortality ratio (SMR) was calculated. Cox analyses for hypothesized predictors of mortality were performed. RESULTS Forty deaths were recorded. SMR was 10.6 [CI 95% (7.6-14.4)]. Six factors at admission were associated with death: older age, longer eating disorder duration, history of suicide attempt, diuretic use, intensity of eating disorder symptoms, and desired body mass index at admission. CONCLUSION Anorexia nervosa in-patients are at high risk of death. This risk can be predicted by both chronicity and seriousness of illness at hospitalization. These elements should be considered as warnings to adapt care provision and could be targeted by treatment.
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McCormick LM, Keel PK, Brumm MC, Watson DB, Forman-Hoffman VL, Bowers WA. A pilot study of personality pathology in patients with anorexia nervosa: modifiable factors related to outcome after hospitalization. Eat Weight Disord 2009; 14:e113-20. [PMID: 19934624 DOI: 10.1007/BF03327808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To assess improvement in aspects of personality in patients hospitalized with anorexia nervosa (AN) and its relationship to improved depression, body mass index (BMI), and eating disorder outcome after treatment. METHOD Twenty females hospitalized with AN completed intake and discharge assessments of BMI, depression and eating disorder severity, as well as personality pathology with the Minnesota Multiphasic Personality Inventory (MMPI-2) and the Revised NEO Personality Inventory (NEO PI-R). Clinical outcome for a subset of patients at 1-year post-hospitalization was determined. RESULTS The only factor that predicted better versus worse outcome at 1-year post-hospitalization was change in Low Self-Esteem (LSE) from the MMPI-2. Improved LSE from admission to discharge predicted remission at 1-year post-hospitalization, while worsening LSE predicted relapse. Regardless of outcome, NEO PI-R Neuroticism remained pathologically elevated in AN patients during hospitalization. DISCUSSION Pathological levels of neuroticism may represent a vulnerability factor for AN. In contrast, self-esteem appears to be a modifiable factor that predicts outcome following hospitalization, and may be an important target for treatment.
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Abstract
OBJECTIVE The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center systematically reviewed evidence on factors associated with outcomes among individuals with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) and whether outcomes differed by sociodemographic characteristics. METHOD We searched electronic databases including MEDLINE and reviewed studies published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes. RESULTS At followup, individuals with AN were more likely than comparisons to be depressed, have Asperger's syndrome and autism spectrum disorders, and suffer from anxiety disorders including obsessive-compulsive disorders. Mortality risk was significantly higher than what would be expected in the population and the risk of suicide was particularly pronounced. The only consistent factor across studies relating to worse BN outcomes was depression. A substantial proportion of individuals continue to suffer from eating disorders over time but BN was not associated with increased mortality risk. Data were insufficient to draw conclusions concerning factors associated with BED outcomes. Across disorders, little to no data were available to compare results based on sociodemographic characteristics. CONCLUSION The strength of the bodies of literature was moderate for factors associated with AN and BN outcomes and weak for BED.
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Affiliation(s)
- Nancy D Berkman
- RTI International, Research Triangle Park, North Carolina, USA
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Abstract
OBJECTIVE Lack of participation in follow-ups is thought to be a serious bias in outcome research on eating disorders; however, little systematic knowledge exists about the problem. The present study aimed to delineate non-participation in long-term follow-up research, and explore the reasons for non-participation. METHOD Eating disorder patients (N=840) entering a naturalistic, longitudinal multi-centre study were divided into participators (N=508) and non-participators (N=332) in 36-month follow-ups. Non-participators were further classified as either active (i.e. refused participation or failed to attend scheduled appointments) or passive non-participators (i.e. could not be traced). RESULTS Active non-participators exhibited significantly lower levels of general and eating disorder psychopathology at intake compared to participators, while passive non-participators reported higher levels of hostility. DISCUSSION Systematic exploration of non-participation in longitudinal research can help to mitigate the problem of indistinct results due to missing data. Barriers to successful longitudinal research and how to overcome non-participation at endpoint are discussed.
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Affiliation(s)
- T Björk
- Psychiatric Research Centre, Orebro County Council, S-701 16 Orebro, Sweden.
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Signorini A, De Filippo E, Panico S, De Caprio C, Pasanisi F, Contaldo F. Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. Eur J Clin Nutr 2006; 61:119-22. [PMID: 16885933 DOI: 10.1038/sj.ejcn.1602491] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate long-term mortality rate of anorexia nervosa (AN) patients in a southern Italy population compared to the most recent literature. DESIGN Retrospective and review setting. PATIENTS AND INTERVENTIONS One hundred and forty-seven female AN patients, consecutively admitted from 1994 to 1997 to the Outpatient Unit, were re-examined between June and November 2003. Our data are compared with 10 other studies published since 1988. RESULTS One hundred and twenty-three deaths in 2240 patients, amounting to a total mortality rate of 5.25% were reported in the literature. Deaths due to suicide, AN-related and AN-unrelated diseases were 1.20, 3.07 and 0.98%, respectively. After correcting for unrelated deaths, mortality rate was 4.27%. In our 8-year follow-up, we found a mortality rate of 2.72% (1.82% after correcting for unrelated deaths). Standardized mortality ratio was 9.7. CONCLUSION We interpret our favourable findings as a consequence of an integrated, clinical-nutritional and psychiatric approach. Finally, considering AN demographic characteristics, that is young female subjects in Westernized societies, mortality rate is confirmed to be dramatically high.
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Affiliation(s)
- A Signorini
- 1Department of Clinical and Experimental Medicine, Interuniversity Centre for Obesity and Eating Disorders, University Federico II, Naples, Italy
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Abstract
OBJECTIVE The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). METHOD Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. RESULTS The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. CONCLUSION Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.
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Abstract
OBJECTIVE In a long-term follow-up of anorexia nervosa (AN) patients, somatic, psychological and social variables at clinical presentation should be investigated using a multilevel approach. METHODS This study isolated predictors known from the literature over longer time periods and carried out a separate investigation of predictors in a sample of 81 AN patients of the Heidelberg-Mannheim study over a mean period of 12 years (range 9-19 years). Separate hierarchic regression analyses on the basis of the course of the Morgan-Russell categories were calculated for four individually recorded areas: anamnestic, psychological, somatic and social data sets. RESULTS Age at the onset of the disease, purging behavior, low serum albumin, high glutamic-oxalo acetic transaminase (GOT) psychopathology (ANSS) and social pathology had the highest predictive value qualities. In survival analysis overall assessment of all six main predictors at clinical presentation could differentiate all patients who recovered from those who remained ill (log-rank test P = 0.019). CONCLUSION A small number of variables were important for detecting a good or poor long-term course of AN. At onset of the disease, it seems necessary to evaluate these psychological, somatic and social predictors.
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Affiliation(s)
- H C Deter
- Department of Psychosomatics, University Medical Center Benjamin Franklin, Free University Berlin, Germany.
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Tonoike T, Takahashi T, Watanabe H, Kimura H, Suwa M, Akahori K, Itakura Y. Treatment with intravenous hyperalimentation for severely anorectic patients and its outcome. Psychiatry Clin Neurosci 2004; 58:229-35. [PMID: 15149286 DOI: 10.1111/j.1440-1819.2004.01224.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In treating patients with severe anorexia nervosa, it is important to improve their physical condition first. Patients who had lost close to 60% standard bodyweight (SBW) were candidates for inpatient treatment due to the mortality risk. With 80% SBW as the target for therapy, they were given both intravenous hyperalimentation and food by oral intake in order to improve their physical condition. In total, 51 patients were admitted. One died and four patients dropped out in the course of treatment. Forty-six patients who completed the inpatient treatment were reviewed. Although admitted with an average weight of approximately 60% SBW, they were discharged with a weight of approximately 80% SBW after approximately 60 days. An average follow up of 25.0 months was conducted, and two patients were found to have died. The mean weight, percentage resuming menstruation, and rehospitalization rate of the 44 survivors were 79% SBW, 23%, and 32%, respectively. The patients with the restricting type of anorexia had an earlier onset of the disorder and a better social outcome. Patients in whom onset occurred at a younger age had a better social outcome. After being discharged, the majority of the patients continued treatment as outpatients. Although the results were similar to those of conventional studies in terms of outcome, the shorter hospitalization was significant. Overall, in the treatment of patients with severe anorexia nervosa, it is important to begin psychotherapy while trying to improve their physical condition.
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Affiliation(s)
- Takashi Tonoike
- Department of Psychiatry, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
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Heinberg LJ, Haug NA, Freeman YLM, Ambrose D, Guarda AS. Clinical course and short-term outcome of hospitalized adolescents with eating disorders: the success of combining adolescents and adults on an eating disorders unit. Eat Weight Disord 2003; 8:326-31. [PMID: 15018385 DOI: 10.1007/bf03325035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Although significant controversy exists regarding the appropriate setting for treating adolescents with eating disorders, empirical studies have been lacking. This study aimed to evaluate, and compare with adults, the clinical course and short-term outcome of adolescents with eating disorders hospitalized on an adult eating disorders unit. One hundred forty-four consecutive inpatient admissions on a weight gain protocol (28% minors and 72% adults) completed psychometric measures and were assessed on clinical indices. No differences between minors and adults were demonstrated for weight gain per week on either inpatient or partial hospitalization admissions. Whereas inpatient length of stay was equivalent, adolescents stayed significantly longer in partial hospitalization than adults. Minors did not differ from adults on the presence of problematic eating disordered behaviors or most psychometric measures, although they had less functional interference due to their eating disorders. Results suggest that an adult eating disorders specialty program can be an appropriate and efficacious setting for adolescents.
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Affiliation(s)
- L J Heinberg
- Case Western Reserve University School of Medicine, Department of Psychiatry, Cleveland, OH 44106, USA.
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Uher R, Brammer MJ, Murphy T, Campbell IC, Ng VW, Williams SCR, Treasure J. Recovery and chronicity in anorexia nervosa: brain activity associated with differential outcomes. Biol Psychiatry 2003; 54:934-42. [PMID: 14573322 DOI: 10.1016/s0006-3223(03)00172-0] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The course of anorexia nervosa varies from rapid recovery to a chronic debilitating illness. This study aimed to identify functional neural correlates associated with differential outcomes. METHODS Brain reactions to food and emotional visual stimuli were measured with functional magnetic resonance imaging in nine women who had long-term recovery from restricting anorexia nervosa. These were compared with age- and education-matched groups of eight women chronically ill with restricting anorexia nervosa and nine healthy control women. RESULTS In response to food stimuli, increased medial prefrontal and anterior cingulate activation, as well as a lack of activity in the inferior parietal lobule, differentiated the recovered group from the healthy control subjects. Increased activation of the right lateral prefrontal, apical prefrontal, and dorsal anterior cingulate cortices differentiated these recovered subjects from chronically ill patients. Group differences were specific to food stimuli, whereas processing of emotional stimuli did not differ between groups. CONCLUSIONS Separate neural correlates underlie trait and state characteristics of anorexia nervosa. The medial prefrontal response to disease-specific stimuli may be related to trait vulnerability. Lateral and apical prefrontal involvement is associated with a good outcome.
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Affiliation(s)
- Rudolf Uher
- Institute of Psychiatry, King's College, London, United Kingdom
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Okamoto A, Yamashita T, Nagoshi Y, Masui Y, Wada Y, Kashima A, Arii I, Nakamura M, Fukui K. A behavior therapy program combined with liquid nutrition designed for anorexia nervosa. Psychiatry Clin Neurosci 2002; 56:515-20. [PMID: 12193240 DOI: 10.1046/j.1440-1819.2002.01047.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have introduced behavior therapy as standard in-patient treatment for anorexia nervosa and have modified the treatment program. At first, we used Fukamachi's activity restriction therapy (FT), followed by Token economy therapy (TET), which combined token economy with FT. Finally, we have developed Kyoto Prefectural University of Medicine Behavior Therapy (KPT). According to KPT, only liquid formula is given in the early stages of hospitalization and a target weight is not set at admission. We examined the effect of these three programs with respect to bodyweight gain. Thirty-five anorexic patients participated in these three programs in our hospital: seven completed FT, seven completed TET and 21 completed KPT. We compared the effects of these three programs on body mass index (BMI). Furthermore, the effects of these three programs on BMI were compared at admission, 1 month after admission and at discharge, 6 months after discharge. In addition, the rate of increase of BMI for the following three periods was investigated: 1 month after admission, total hospitalization (from admission to discharge) and from admission to 6 months after discharge. The result is that KPT was the most effective of the three programs with regard to both the amount and the rate of increase of BMI at all points and there is a significant difference between KPT and FT. This effectiveness may be attributable to the use of an oral liquid formula, the setting of target weight at a later stage of hospitalization and the release of activity restriction based on weight gain.
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Affiliation(s)
- Akiko Okamoto
- Department of Psychiatry, Kyoto Prefectural University of Medicine, Japan.
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