1
|
Driscoll DJO, Fagan J, Jennings R, Clifford M, Maher C, Corbett M, Wade S, McDevitt S. National Clinical Programme for Eating Disorders: a pragmatic review of a new national eating disorder service in Ireland. Ir J Psychol Med 2024; 41:68-77. [PMID: 35678376 DOI: 10.1017/ipm.2022.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Health Service Executive National Clinical Programme for Eating Disorders (NCPED) launched a Model of Care for Eating Disorder Services in Ireland in 2018. Currently, one adult and two child and adolescent eating disorder services are operational out of a total of sixteen recommended. The three objectives of this paper are to describe the early (1) referral pattern, (2) level of service activity and (3) the level of service user satisfaction. METHOD Monthly submitted service activity data from each service to the NCPED between March 2018 and October 2020 were retrospectively analysed. One hundred and fifty-nine carers and service users completed an experience of service questionnaire (ESQ). A descriptive analysis of referral pattern, level of service activity and ESQ was performed. A thematic analysis was performed on three qualitative questions on the ESQ. RESULTS There was substantial referral numbers to eating disorder services by 18 months (n = 258). The main referral source was community mental health teams. The majority (n = 222, 86%) of referrals were offered an assessment. The most common age profile was 10-17 years of age (n = 120, 54.1%), and anorexia nervosa was the most common disorder (n = 96, 43.2%). ESQ results demonstrate that most service users were satisfied with their service, and the main themes were carer involvement, staff expertise, therapeutic alliance and service access. CONCLUSIONS This preliminary service activity and service user satisfaction data highlight several issues, including trends when setting up a regional eating disorder service, potential pitfalls of pragmatic data collection and the need for adequate information-technology infrastructure.
Collapse
Affiliation(s)
- David J O Driscoll
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
| | - Jennifer Fagan
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Linn Dara Child & Adolescent Mental Health Services, Eating Disorder Service, Cherry Orchard Hospital, Dublin, Ireland
| | - Rhona Jennings
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
| | - Michelle Clifford
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Linn Dara Child & Adolescent Mental Health Services, Eating Disorder Service, Cherry Orchard Hospital, Dublin, Ireland
| | - Caroline Maher
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- Eating Disorder Service, St. Vincent's University Hospital, Dublin, Ireland
| | - Marie Corbett
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
| | | | - Sara McDevitt
- Cork and Kerry Regional Eating Disorder Service, National Clinical Programme for Eating Disorders (CAREDS), St. Stephens Hospital, Glanmire, Cork, Ireland
- Health Service Executive, National Clinical Programme for Eating Disorders, Dublin, Ireland
- University College Cork, Cork, Ireland
| |
Collapse
|
2
|
Smith S, Sutandar K, Woodside B. Premature termination of inpatient eating disorder treatment: Does timing matter? J Eat Disord 2023; 11:210. [PMID: 38012804 PMCID: PMC10680217 DOI: 10.1186/s40337-023-00934-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.
Collapse
Affiliation(s)
- Sarah Smith
- Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, 25 Sheppard Ave West, Suite 300, Toronto, ON, M2N 6S6, Canada
| | - Blake Woodside
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
| |
Collapse
|
3
|
Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
Collapse
Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
| |
Collapse
|
4
|
Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
Collapse
Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
5
|
Glasofer DR, Muratore AF, Attia E, Wu P, Wang Y, Minkoff H, Rufin T, Walsh BT, Steinglass JE. Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa. J Eat Disord 2020; 8:69. [PMID: 33292619 PMCID: PMC7709230 DOI: 10.1186/s40337-020-00348-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. METHODS Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual's likelihood of maintaining inpatient treatment gains. RESULTS One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. CONCLUSIONS Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.
Collapse
Affiliation(s)
- Deborah R Glasofer
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA.
| | - Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
- Center for Eating Disorders, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA
| | - Peng Wu
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Hillary Minkoff
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Teresa Rufin
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York City, NY, 10032, USA
| |
Collapse
|
6
|
Harrison A, Stavri P, Tchanturia K. Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A). NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:163-176. [PMID: 33252714 DOI: 10.1007/s40211-020-00375-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits. METHODS An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a 10-session individual format delivered to a case series of 12 patients and a 5-session group format delivered to 3 groups of 9 patients. RESULTS Acceptability, measured using a Patient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats. CONCLUSION Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.
Collapse
Affiliation(s)
- Amy Harrison
- Department of Psychology and Human Development, University College London, 25 Woburn Square, WC1H 0AA, London, UK.
| | - Pamela Stavri
- Ellern Mede Service for Eating Disorders, Holcombe Hill, The Ridgeway, NW7 4HX, Mill Hill, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
| |
Collapse
|
7
|
Hughes EK. Comorbid depression and anxiety in childhood and adolescent anorexia nervosa: Prevalence and implications for outcome. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00034.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth K. Hughes
- Department of Paediatrics, University of Melbourne
- Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Schwartz C, Drexl K, Fischer A, Fumi M, Löwe B, Naab S, Voderholzer U. Universal prevention in eating disorders: A systematic narrative review of recent studies. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.mph.2019.200162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
9
|
Gregertsen EC, Mandy W, Kanakam N, Armstrong S, Serpell L. Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis. Psychiatry Res 2019; 271:484-501. [PMID: 30551081 DOI: 10.1016/j.psychres.2018.11.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.
Collapse
Affiliation(s)
- Eva C Gregertsen
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - William Mandy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | | | | | - Lucy Serpell
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, London, UK
| |
Collapse
|
10
|
Treasure J, Cardi V. Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture? EUROPEAN EATING DISORDERS REVIEW 2017; 25:139-147. [PMID: 28402069 DOI: 10.1002/erv.2511] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/13/2022]
Abstract
Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| |
Collapse
|
11
|
Ung EM, Erichsen CB, Poulsen S, Lau ME, Simonsen S, Davidsen AH. The association between interpersonal problems and treatment outcome in patients with eating disorders. J Eat Disord 2017; 5:53. [PMID: 29201364 PMCID: PMC5697343 DOI: 10.1186/s40337-017-0179-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interpersonal problems are thought to play an essential role in the development and maintenance of eating disorders. The aim of the current study was to investigate whether a specific interpersonal profile could be identified in a group of patients diagnosed with Bulimia Nervosa, Binge Eating Disorder, or Eating Disorders Not Otherwise Specified, and to explore if specific types of interpersonal problems were systematically related to treatment outcome in this group of patients. METHODS The participants were 159 patients who received systemic/narrative outpatient group psychotherapy. Interpersonal problems were measured at baseline, and eating disorder symptoms were measured pre- and post treatment. Data were analysed with the Structural Summary Method, a particular method for the analysis of the Inventory of Interpersonal Problems, and hierarchical regression analysis was conducted. RESULTS The patients demonstrated a generally Non-assertive and Friendly-submissive interpersonal style. No significant association between the overall level of interpersonal problems and treatment outcome was identified. However, the results showed a correlation between being cold and hostile and poor treatment outcome, while being domineering showed a trend approaching significance in predicting better treatment outcome. CONCLUSION The results indicate that patients with eating disorders show a specific interpersonal profile, and suggest that particular types of interpersonal problems are associated with treatment outcome.
Collapse
Affiliation(s)
- Elise Meyn Ung
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Cecilie Birkmose Erichsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Marianne Engelbrecht Lau
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820 Gentofte, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820 Gentofte, Denmark
| | - Annika Helgadóttir Davidsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Stolpegaardsvej 20, 2820 Gentofte, Denmark
| |
Collapse
|
12
|
Ter Huurne ED, Postel MG, de Haan HA, van der Palen J, DeJong CAJ. Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders. Psychiatry Res 2017; 247:182-193. [PMID: 27918968 DOI: 10.1016/j.psychres.2016.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 10/04/2016] [Accepted: 11/26/2016] [Indexed: 02/08/2023]
Abstract
Treatment dropout is an important concern in eating disorder treatments as it has negative implications for patients' outcome, clinicians' motivation, and research studies. Our main objective was to conduct an exploratory study on treatment dropout in a two-part web-based cognitive behavioral therapy with asynchronous therapeutic support. The analysis included 205 female patients with eating disorders. Reasons for dropout, treatment experiences, and predictors of dropout were analyzed. Overall treatment dropout was 37.6%, with 18.5% early dropout (before or during treatment part 1) and 19.0% late dropout (after part 1 or during part 2). Almost half of the participants identified personal circumstances as reason for dropout. The other participants mostly reported reasons related to the online delivery or treatment protocol. Predictors of early dropout included reporting less vigor and smoking at baseline and a longer average duration per completed treatment module of part 1. Late dropout was predicted by reporting less vigor at baseline and uncertainty about recommendation of the treatment to others after completion of treatment part 1. Generally, the web-based treatment and online therapeutic support were evaluated positively, although dropouts rated the treatment as significantly less helpful and effective than completers did.
Collapse
Affiliation(s)
- Elke D Ter Huurne
- Tactus Addiction Treatment, Enschede, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.
| | - Marloes G Postel
- Tactus Addiction Treatment, Enschede, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands; Department of Psychology Health & Technology, University of Twente, Enschede, The Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment, Enschede, The Netherlands; Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Cor A J DeJong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands; Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Roux H, Ali A, Lambert S, Radon L, Huas C, Curt F, Berthoz S, Godart N. Predictive factors of dropout from inpatient treatment for anorexia nervosa. BMC Psychiatry 2016; 16:339. [PMID: 27716113 PMCID: PMC5045614 DOI: 10.1186/s12888-016-1010-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.
Collapse
Affiliation(s)
- H. Roux
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - A. Ali
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - S. Lambert
- Service d’Addictologie, CHU Nantes, Paris, France
| | - L. Radon
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - C. Huas
- Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - F. Curt
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - S. Berthoz
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - Nathalie Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France. .,Faculté de Médecine, Université Paris Descartes, Paris, France. .,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France. .,Université Paris Descartes, Paris, France. .,Université Paris Sud, Villejuif, France. .,UVSQ, Villejuif, France. .,Université Paris-Saclay, Villejuif, France.
| | | |
Collapse
|
14
|
Smethurst L, Kuss D. ‘Learning to live your life again’: An interpretative phenomenological analysis of weblogs documenting the inside experience of recovering from anorexia nervosa. J Health Psychol 2016; 23:1287-1298. [DOI: 10.1177/1359105316651710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the construct of recovery from anorexia nervosa through the medium of weblogs, focusing on the benefits and barriers to the recovery process. Data were extracted from female ( n = 7) and male ( n = 1) participants’ textual pro-recovery weblogs, all of which were posted between 2013 and 2015 in the public domain. Data were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (1) barriers to recovery, (2) factors increasing the likelihood of recovery and (3) support. Results suggest supportive relationships, regaining control and recognising the consequences of the eating disorder benefit recovery, whereas public perceptions, the anorexia nervosa voice and time act as barriers to recovery. Out of eight participants, four described seeking professional help as part of their recovery, of which three believed their professional therapy experience helped aid recovery. Implications for anorexia nervosa treatment are discussed in detail.
Collapse
|
15
|
Bridges AN, Wormley KA, Leavitt IW, McCord DM. Personality differences in treatment-seeking and non-treatment-seeking individuals with self-reported anorexia. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2015-0116/ijamh-2015-0116.xml. [PMID: 27060734 DOI: 10.1515/ijamh-2015-0116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/17/2016] [Indexed: 06/05/2023]
Abstract
Research on anorexia has tended to focus on individuals who are seeking treatment, leading to treatment models that are based on individuals already receiving help. Therefore, the purpose of this study was to explore personality differences between individuals seeking treatment and those not seeking treatment for anorexia. Participants were 148 women recruited from three online sources. They completed a personality measure derived from the five-factor model and the Eating Attitudes Test-26. Results indicated that individuals with anorexia who were not seeking treatment scored lower on Agreeableness and Conscientiousness than both individuals seeking treatment and a control group. Also, individuals with anorexia in general tended to score lower on Extraversion and higher on Neuroticism than individuals in a control group. These results suggest that being open about treatment options, increasing successes, motivation, and organization, and highlighting the seriousness of anorexia could be beneficial in getting individuals with anorexia to seek and continue in treatment.
Collapse
|
16
|
Kolnes LJ. 'Feelings stronger than reason': conflicting experiences of exercise in women with anorexia nervosa. J Eat Disord 2016; 4:6. [PMID: 26962455 PMCID: PMC4784414 DOI: 10.1186/s40337-016-0100-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/02/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals with anorexia nervosa frequently feel ambivalent about treatment and weight restoration, and drop out and relapse rates in treatment are high. Increased insight into the function of the eating disorder is considered essential for achieving long-lasting, meaningful change. However, research investigating the functions of anorexia nervosa tends to focus on the role of the disease per se. Distinctions are rarely made across features. In particular, the subjective experience, understanding and sense making of the engagement in compulsive exercise in individuals with anorexia nervosa has received little attention. By using a qualitative methodological approach, this paper aims to expand on prior findings by examining how patients with anorexia nervosa understand and make sense of the experience of exercise in the context of their lives and treatment programme. METHODS Semi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA). RESULTS Two overarching themes emerged in the analysis of the larger study of which this paper is a part; 'paradoxical functions of exercise' and 'diverging experiences of exercise'. Diverging experiences of exercise is the focus of this paper. Firstly, in spite of being severely underweight and suffering from exhaustion, as well as having a clear awareness of the associated negative health effects, participants were engaged in a continuous cycle of rigorous and excessive exercise, which consumed extensive amounts of time and energy. Secondly, the results demonstrate how exercise routines negatively control and interfere with the participants' involvement in the social world. Thirdly, the manner in which participants speak about their exercise reveals their wording to be characterized by efforts to downplay the extent of their actual immersion in exercise. Issues of control and ambivalence about treatment and recovery can be considered potential triggers for the participants' engagement with exercise. Implicit meanings are elaborated upon and discussed in relation to existing literature. CONCLUSIONS The material provides increased insight into the multi-layered meanings of exercise for individuals with anorexia nervosa. It also suggests alternatives to current ways of understanding and approaching exercise that may enable this issue to be addressed in a more meaningful way in therapy. Qualitative approaches can make a valuable contribution to furthering such understanding.
Collapse
Affiliation(s)
- Liv-Jorunn Kolnes
- Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway
| |
Collapse
|
17
|
Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 309] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
Collapse
Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
18
|
The Freiburg sport therapy program for eating disordered outpatients: a pilot study. Eat Weight Disord 2015; 20:319-27. [PMID: 25694219 DOI: 10.1007/s40519-015-0182-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Many patients with anorexia or bulimia nervosa use physical activity as a method to influence weight and shape and/or exercise in a compulsive manner. This form of exercising is associated with a more severe illness and higher relapse rates. In a proof-of-concept study, effects of a newly developed sport therapy program aiming to reduce unhealthy exercising were assessed. METHODS Thirty-six patients with eating disorders took part in four group terms of the program, each lasting 3 months. They were compared to a matched control group. Main outcome criterion was a reduction in the total score of the commitment to exercise scale (CES). RESULTS In the completer analysis, we found statistically significant reductions in the CES total score over time (time × group; p = 0.003) and significant improvements in overall eating psychopathology and quality of life (pre → post). The dropout rate was high (34 %), mainly due to external reasons (time schedule, etc.). CONCLUSIONS Findings point to specific effects of a newly developed outpatient sport therapy program for eating disorders. Detailed assessments of patients before assigning them to the program will be necessary to reduce dropout rates. The next step has to be a randomized controlled study.
Collapse
|
19
|
Andries A, Gram B, Støving RK. Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial. Eat Weight Disord 2015; 20:13-21. [PMID: 24890912 DOI: 10.1007/s40519-014-0132-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/12/2014] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The level of physical activity is inappropriately high in up to 80% of the patients suffering of anorexia nervosa (AN), as a result of conscious efforts to lose weight, affect regulation and biological adaptive changes to starvation induced by hypothermia and neuroendocrine mechanisms. The purposes of this paper were to (1) assess the effect of dronabinol-a synthetic cannabinoid agonist-on physical activity in patients with chronic and stable AN, and to (2) unravel the role of leptin and cortisol in this process. METHODS This prospective, randomised, double-blind, crossover study was conducted at a specialised care centre for eating disorders. Twenty-four adult women with AN of at least 5-year duration received either the dronabinol-placebo or placebo-dronabinol sequence. Physical activity was monitored during the fourth week of each intervention. Body weight, leptin and urinary free cortisol excretion were measured repeatedly during the trial. Changes in behavioural dimensions related to AN were assessed by Eating Disorder Inventory-2. RESULTS The total duration of physical activity did not change, while its average intensity increased by 20% (P = 0.01) during dronabinol therapy, resulting in an increased energy expenditure with 68.2 kcal/day (P = 0.01) above placebo. CONCLUSIONS This randomised, double-blind study revealed that cannabinoid agonist treatment was associated with a modest increase in physical activity in adult women with severe and longstanding AN. Additionally, we detected a strong relationship between the circulating levels of leptin and physical activity in these chronically undernourished patients.
Collapse
Affiliation(s)
- Alin Andries
- Department of Endocrinology, Centre for Eating Disorders, Odense University Hospital, 5000, Odense, Denmark,
| | | | | |
Collapse
|
20
|
Jones A, Lindekilde N, Lübeck M, Clausen L. The association between interpersonal problems and treatment outcome in the eating disorders: A systematic review. Nord J Psychiatry 2015; 69:563-73. [PMID: 25768663 DOI: 10.3109/08039488.2015.1019924] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review systematically the eating disorder literature in order to examine the association between pre-treatment interpersonal problems and treatment outcome in people diagnosed with an eating disorder. METHODS Six relevant databases were searched for studies in which interpersonal problems prior to treatment were examined in relation to treatment outcome in patients diagnosed with anorexia nervosa (AN), bulimia nervosa (BN) or eating disorders not otherwise specified (EDNOS). RESULTS Thirteen studies were identified (containing 764 AN, 707 BN and 48 EDNOS). The majority of studies indicated that interpersonal problems at the start of therapy were associated with a detrimental treatment outcome. CONCLUSIONS Individuals with a binge/purge-type of eating disorder may be particularly vulnerable to interpersonal issues and these issues may lead to poorer treatment recovery by reducing the individual's ability to engage in the treatment process on a functional level. The clinical and research implications are discussed.
Collapse
Affiliation(s)
- Allan Jones
- a Allan Jones, Institute of Psychology, University of Southern Denmark , Denmark
| | - Nanna Lindekilde
- b Nanna Lindekilde, Institute of Psychology, University of Southern Denmark , Denmark
| | - Marlene Lübeck
- c Marlene Lübeck, Institute of Psychology, University of Southern Denmark , Denmark
| | - Loa Clausen
- d Loa Clausen, Centre of Child- and Adolescent Psychiatry, Aarhus University Hospital , Risskov , Denmark
| |
Collapse
|
21
|
Schlegl S, Quadflieg N, Löwe B, Cuntz U, Voderholzer U. Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes. BMC Psychiatry 2014; 14:258. [PMID: 25193513 PMCID: PMC4172844 DOI: 10.1186/s12888-014-0258-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/29/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies have predominantly evaluated the effectiveness of inpatient treatment for anorexia nervosa at the group level. The aim of this study was to evaluate treatment outcomes at an individual level based on the clinical significance of improvement. Patients' treatment outcomes were classified into four groups: deteriorated, unchanged, reliably improved and clinically significantly improved. Furthermore, the study set out to explore predictors of clinically significant changes in eating disorder psychopathology. METHODS A total of 435 inpatients were assessed at admission and at discharge on the following measures: body-mass-index, eating disorder symptoms, general psychopathology, depression and motivation for change. RESULTS 20.0-32.0% of patients showed reliable changes and 34.1-55.3% showed clinically significant changes in the various outcome measures. Between 23.0% and 34.5% remained unchanged and between 1.7% and 3.0% deteriorated. Motivation for change and depressive symptoms were identified as positive predictors of clinically significant changes in eating disorder psychopathology, whereas body dissatisfaction, impulse regulation, social insecurity and education were negative predictors. CONCLUSIONS Despite high rates of reliable and clinically significant changes following intensive inpatient treatment, about one third of anorexia nervosa patients showed no significant response to treatment. Future studies should focus on the identification of non-responders as well as on the development of treatment strategies for these patients.
Collapse
Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ulrich Cuntz
- Schoen Klinik Roseneck, Prien, Germany ,Paracelsus Medical University, Salzburg, Austria
| | - Ulrich Voderholzer
- Schoen Klinik Roseneck, Prien, Germany ,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| |
Collapse
|
22
|
Jordan J, McIntosh VVW, Carter FA, Joyce PR, Frampton CMA, Luty SE, McKenzie JM, Bulik CM. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:278-84. [PMID: 24842307 DOI: 10.1002/erv.2296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022]
Abstract
AIM The literature on clinical characteristics associated with premature termination of treatment (PTT) is beset with conflicting and non-replicated findings. This study explores clinical characteristics potentially associated with PTT in a randomised controlled outpatient psychotherapy trial for anorexia nervosa (AN). METHODS Participants were 56 women aged 17-40 years with spectrum AN. The completer group (n = 35) included those completing at least 15/20 planned sessions with the remainder of the sample comprising the PTT group (n = 21). Variables examined included demographic factors, psychosocial functioning, psychiatric history, lifetime comorbidity, temperament and eating disorder characteristics. Logistic regression was used to examine significant variables. A Kaplan-Meier survival curve was used to illustrate time taken to PTT. RESULTS The mean number of sessions in the PTT group was 8.1. Lower self-transcendence scores on the Temperament and Character Inventory were associated with PTT. CONCLUSIONS Recognising and addressing personality factors have the potential to enhance retention in treatment.
Collapse
Affiliation(s)
- Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
| | | | | | | | | | | | | | | |
Collapse
|
23
|
von Brachel R, Hötzel K, Hirschfeld G, Rieger E, Schmidt U, Kosfelder J, Hechler T, Schulte D, Vocks S. Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout. J Med Internet Res 2014; 16:e92. [PMID: 24686856 PMCID: PMC4004149 DOI: 10.2196/jmir.3104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. OBJECTIVE The aim of the present study was to identify predictors of dropout from this Web program. METHODS A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. RESULTS The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. CONCLUSIONS Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
Collapse
Affiliation(s)
- Ruth von Brachel
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Andries A, Frystyk J, Flyvbjerg A, Støving RK. Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. Int J Eat Disord 2014; 47:18-23. [PMID: 24105610 DOI: 10.1002/eat.22173] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/07/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The evidence for pharmacological treatment of severe, longstanding anorexia nervosa (AN) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs. The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist on body weight and eating disorder-related psychopathological personality traits in women with severe, enduring AN. METHOD This add-on, prospective, randomized, double blind, controlled crossover study was conducted between 2008 and 2011 at a specialized care center for eating disorders. Twenty-five women over 18 years with AN of at least 5 years duration were randomized to treatment with either dronabinol-placebo or placebo-dronabinol. In addition to the standardized baseline therapeutic regime, the participants received dronabinol, 2.5 mg twice daily for 4 weeks and matching placebo for 4 weeks, separated by a 4-week wash-out period. Primary outcome was the mean change in body weight. Secondary outcome was score changes on the Eating Disorder Inventory-2 (EDI-2). Data were analyzed for the 24 patients who completed the trial. RESULTS During dronabinol treatment, participants gained 0.73 kg (t = 2.86, df = 22, p < 0.01) above placebo without significant psychotropic adverse events. Dronabinol significantly predicted weight gain in a multiple linear regression including EDI-2 body dissatisfaction score and leptin. EDI-2 subscale scores showed no significant changes over time. DISCUSSION Dronabinol therapy was well tolerated. During four weeks of exposure it induced a small but significant weight gain in the absence of severe adverse events.
Collapse
Affiliation(s)
- Alin Andries
- Center for Eating Disorders, Department of Endocrinology, Odense University Hospital, DK-5000, Odense C, Denmark
| | | | | | | |
Collapse
|
25
|
Goddard E, Hibbs R, Raenker S, Salerno L, Arcelus J, Boughton N, Connan F, Goss K, Laszlo B, Morgan J, Moore K, Robertson D, S S, Schreiber-Kounine C, Sharma S, Whitehead L, Schmidt U, Treasure J. A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 2013; 13:287. [PMID: 24200194 PMCID: PMC3871017 DOI: 10.1186/1471-244x-13-287] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/15/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. METHOD Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). RESULTS One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. CONCLUSIONS Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour may influence the response to inpatient care, as may improved social functioning and confidence to change.
Collapse
Affiliation(s)
- Elizabeth Goddard
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Laura Salerno
- Department of Psychology, University of Palermo, Palermo, Italy
| | - Jon Arcelus
- Eating Disorders Service, Brandon Unit, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Nicky Boughton
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK
| | - Ken Goss
- Eating Disorders Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - Bert Laszlo
- Wonford House Hospital, Devon Partnership NHS Trust, Exeter, UK
| | - John Morgan
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | - Kim Moore
- Kinver Centre, Eating Disorders, South Staffordshire and Shropshire NHS Foundation Trust, Staffordshire, UK
| | - David Robertson
- National Centre for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Saeidi S
- Yorkshire Centre for Eating Disorders, Leeds and St George’s University of London, Leeds, UK
| | | | - Sonu Sharma
- Eating Disorders Service, The Priory Hospital Cheadle Royal, Manchester, UK
| | - Linette Whitehead
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King’s College London, Institute of Psychiatry, London, UK
| |
Collapse
|
26
|
Hubert T, Pioggiosi P, Huas C, Wallier J, Maria AS, Apfel A, Curt F, Falissard B, Godart N. Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa. Psychiatry Res 2013; 209:632-7. [PMID: 23639255 DOI: 10.1016/j.psychres.2013.03.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n=86) of hospitalizations; in 42.3% (n=30) of the cases, dropout was initiated by the treatment team and in 58.6% (n=41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic.
Collapse
Affiliation(s)
- Tamara Hubert
- Department of Psychiatry, Institut Mutualiste Montsouris (IMM), Paris, France; Department of General Practice, Univ Paris 7 Denis Diderot., Paris, France; Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, France; Univ. Paris Ouest Nanterre La Defense, Nanterre, France
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Weiss CV, Mills JS, Westra HA, Carter JC. A preliminary study of motivational interviewing as a prelude to intensive treatment for an eating disorder. J Eat Disord 2013; 1:34. [PMID: 24999413 PMCID: PMC4081789 DOI: 10.1186/2050-2974-1-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/12/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Engaging patients with an eating disorder in change is difficult and intensive treatment programs have high drop-out rates. The purpose of the study was to determine whether Motivational Interviewing (MI) in the form of a brief, pre-treatment intervention would be associated with higher completion rates in subsequent intensive treatment for an eating disorder. Thirty-two participants diagnosed with an eating disorder participated in the study. All participants were on the waitlist for admission to an intensive, hospital-based treatment program. Sixteen participants were randomly assigned to four individual sessions of MI that began prior to entrance into the treatment program (MI condition) and 16 participants were assigned to treatment as usual (control condition). The main outcome was completion of the intensive treatment program. Participants also completed self-report measures of motivation to change. RESULTS Participants in the MI condition were significantly more likely to complete intensive treatment (69% completion rate) than were those in the control condition (31%). CONCLUSIONS MI can be a useful intervention to engage individuals with severe eating disorders prior to participation in intensive treatment. MI as a brief prelude to hospital-based treatment for an eating disorder may help to improve completion rates in such programs. Further research is required to determine the precise therapeutic mechanisms of change in MI.
Collapse
Affiliation(s)
- Carmen V Weiss
- Department of Psychiatry, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Jennifer S Mills
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Henny A Westra
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| |
Collapse
|
29
|
Pingani L, Catellani S, Arnone F, De Bernardis E, Vinci V, Ziosi G, Turrini G, Rigatelli M, Ferrari S. Predictors of dropout from in-patient treatment of eating disorders: an Italian experience. Eat Weight Disord 2012; 17:e290-7. [PMID: 23449083 DOI: 10.1007/bf03325140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The aim of the study was to examine possible risk factors for dropout from in-patient treatment for eating disorders (ED). MATERIALS AND METHODS The present study consisted of a retrospective analysis of clinical and non-clinical available information about 186 patients suffering from ED consecutively admitted into the Villa Maria Luigia Private Hospital (Parma, Italy) in a three-year period (01/01/2006 - 31/12/2009). Sociodemographics, clinical history and current features, and results to the following psychometric instruments were analysed: Eating Disorder Questionnaire (EDQ), Predisposing, On-set and Maintaining risk factors list for Eating Disorders, Eating Disorders Inventory-II, Body Uneasiness Test and SCL-90. RESULTS Of the 186 patients, 46 (24.7%) voluntarily left the treatment program prematurely. Predictive factors included poor educational and professional achievements, parents' divorcing, parents' history of substance abuse and difficulties in interpersonal relationships. DISCUSSION Dropout is a multifactorial phenomenon with deep clinical consequences: the recognition of possible risk factors may support the choice of specific therapeutic strategies to improve the treatment of ED and its outcomes.
Collapse
Affiliation(s)
- L Pingani
- International PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors. J Nerv Ment Dis 2012; 200:807-13. [PMID: 22922238 DOI: 10.1097/nmd.0b013e318266bbba] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
Collapse
|
31
|
Holm JS, Brixen K, Andries A, Hørder K, Støving RK. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: a review of five cases. Int J Eat Disord 2012; 45:93-100. [PMID: 21344467 DOI: 10.1002/eat.20915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency room treatment was extracted from a population-based registration system. RESULTS Personality disorders were diagnosed in all five patients and substance abuse in three patients. In all cases, illness duration was more than 10 years and late onset was seen in two cases. None of the deaths were due to suicide. Involuntary hospital admission was instituted for three patients, but only one patient was compulsory detained more than once. Four patients died after having discontinued treatment. DISCUSSION Compulsory treatment may be of crucial importance in the prevention of fatalities in patients with long-standing AN and psychiatric comorbidity who discontinue treatment.
Collapse
Affiliation(s)
- Janni Schmidt Holm
- Department of Endocrinology, Center for Eating Disorders, Odense University Hospital, Denmark
| | | | | | | | | |
Collapse
|
32
|
Hartmann A, Weber S, Herpertz S, Zeeck A. Psychological treatment for anorexia nervosa: a meta-analysis of standardized mean change. PSYCHOTHERAPY AND PSYCHOSOMATICS 2011; 80:216-26. [PMID: 21494063 DOI: 10.1159/000322360] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/28/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND For the German treatment guidelines for eating disorders, the literature on psychological treatment of anorexia nervosa (AN) was reviewed systematically. As a common meta-analysis of randomized clinical trials proved to be impossible, a review of all available clinical trials was conducted, statistically integrating standardized mean change scores. Research questions comprised differential effects of therapeutic techniques and settings as well as determining which weight gains could be expected. METHODS After an extensive literature search, studies were selected, rated by 3 independent raters. Weight gain as the main outcome criterion was transformed into standardized mean change scores. Effect sizes were checked for homogeneity. RESULTS 57 studies containing 84 treatment arms and 2,273 patients could be integrated. Studies differed considerably in quality. The strongest bias identified was reporting selectively on completers or failures, versus intention-to-treat samples. No significant differences between effect sizes could be identified concerning treatment setting, technique or patient characteristics. If treatment time is taken into account, inpatient treatment produced a faster weight gain than outpatient treatment. CONCLUSION The study describes weight gains which can be reached in outpatient and inpatient settings. It yielded no salient results speaking for a certain therapy technique, setting or procedure. Treatment guidelines for psychological treatment of AN still have to rely on lower level evidence.
Collapse
Affiliation(s)
- Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany. armin.hartmann @ uniklinik-freiburg.de
| | | | | | | | | |
Collapse
|
33
|
Andries A, Støving RK. Cannabinoid-1 receptor agonists: a therapeutic option in severe, chronic anorexia nervosa? ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.11.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
The effect of pre-exposure and recovery type on activity-based anorexia in rats. Appetite 2011; 56:567-76. [DOI: 10.1016/j.appet.2011.01.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/06/2011] [Accepted: 01/22/2011] [Indexed: 11/20/2022]
|
35
|
Huas C, Godart N, Foulon C, Pham-Scottez A, Divac S, Fedorowicz V, Peyracque E, Dardennes R, Falissard B, Rouillon F. Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample. Psychiatry Res 2011; 185:421-6. [PMID: 20546922 DOI: 10.1016/j.psychres.2009.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 11/27/2009] [Accepted: 12/12/2009] [Indexed: 11/29/2022]
Abstract
Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).
Collapse
|
36
|
Sly R, Bamford B. Why are we waiting? The relationship between low admission weight and end of treatment weight outcomes. EUROPEAN EATING DISORDERS REVIEW 2010; 19:407-10. [PMID: 24081716 DOI: 10.1002/erv.1061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inpatient eating disorder units are increasingly being asked to admit patients at lower BMI's, often delaying hospital treatment until medically unavoidable. This paper aims to explore the impact of this trend on treatment outcome. Eighty-two adults with anorexia nervosa admitted to a national inpatient eating disorder ward were assessed for BMI at admission, length of hospitalisation, discharge BMI and re-admission within 1-year post-treatment. In the current study, admission BMI was unrelated to amount of weight gain during treatment or to length of hospital stay. As such patients admitted at lower BMI's had significantly lower BMI's on discharge from treatment. Low admission BMI's were related to significantly higher likelihoods of re-admission within 1 year. This study provides strong evidence for the benefit of early treatment episodes and with more successful treatment outcomes being related to higher weights at start of treatment.
Collapse
Affiliation(s)
- Richard Sly
- Department of Mental Health, St. Georges, University of London, London; South-West London and St. Georges NHS Trust, London.
| | | |
Collapse
|
37
|
Curry J, Ray S. Starving for Support: How Women With Anorexia Receive ‘Thinspiration’ on the Internet. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2010. [DOI: 10.1080/15401383.2010.527788] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Tierney S, Butterfield C, Stringer E, Fox JRE, McGowan L, Furber L. Difficulties in recruiting pregnant women with eating or weight issues. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjom.2010.18.11.79559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Tierney
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - C Butterfield
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - E Stringer
- Pennine Acute Hospitals NHS Trust, Manchester
| | - JRE Fox
- Division of Health Research, Lancaster University and Eating Disorders Unit, Cheadle Royal Hospital, Cheshire
| | - L McGowan
- School of Nursing, Midwifery and Social Work, University of Manchester
| | - L Furber
- School of Nursing, Midwifery and Social Work, University of Manchester
| |
Collapse
|
39
|
Wallier J, Vibert S, Berthoz S, Huas C, Hubert T, Godart N. Dropout from inpatient treatment for anorexia nervosa: critical review of the literature. Int J Eat Disord 2009; 42:636-47. [PMID: 19208386 DOI: 10.1002/eat.20609] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE High dropout rates from inpatient treatment for Anorexia Nervosa (AN) pose a serious obstacle to successful treatment. Because dropping out of inpatient treatment may have a negative impact on outcome, it is important to understand why dropout occurs so that treatment can be targeted toward keeping patients in care. We therefore conducted a critical literature review of studies on dropout from inpatient treatment for AN. METHOD Searches of Medline and PsycINFO revealed nine articles on this subject. Two were excluded because they did not differentiate AN from other eating disorders in analyses. RESULTS Results were scarce and conflicting, with methodological issues complicating comparisons. Weight on admission, AN subtype, eating disorder symptoms, greater psychiatric difficulty in general, and the absence of depression were related to dropout in multivariate analyses. DISCUSSION Authors should use a common definition of dropout and continue research on the identified predictors as well as potential predictors such as impulsivity and family factors.
Collapse
Affiliation(s)
- Jenny Wallier
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | | | | |
Collapse
|
40
|
Sly R. What's in a name? Classifying ‘the dropout’ from treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2009; 17:405-7. [DOI: 10.1002/erv.964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
41
|
Fassino S, Pierò A, Tomba E, Abbate-Daga G. Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009; 9:67. [PMID: 19818137 PMCID: PMC2765944 DOI: 10.1186/1471-244x-9-67] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 10/09/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs. METHODS All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed. RESULTS The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout. CONCLUSION Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders.
Collapse
Affiliation(s)
- Secondo Fassino
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
| | - Andrea Pierò
- Mental Health Department ASL TO 4, Mental Health Centre, Via Blatta 10, Chivasso, 10034 Turin, Italy
| | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| |
Collapse
|
42
|
Vandereycken W, Vansteenkiste M. Let eating disorder patients decide: Providing choice may reduce early drop-out from inpatient treatment. EUROPEAN EATING DISORDERS REVIEW 2009; 17:177-83. [PMID: 19306300 DOI: 10.1002/erv.917] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Premature drop-out from treatment is a highly prevalent phenomenon among eating disorder (ED) patients. In a specialized inpatient treatment unit a major change was made in the admission strategy in 2001, giving a maximum of personal choice to the patients. A quasi-experimental research was carried out comparing 87 patients treated till 2000 ('old' strategy) with 87 patients treated from 2001 on ('new' strategy). The results indicate that the provision of choice at the beginning of treatment significantly reduced drop-out during the first weeks of inpatient treatment. No differences between both strategies on later drop-out and weight change (in anorexia nervosa patients) during inpatient treatment were found. The results are discussed in the light of the importance placed on dynamics of personal choice, autonomy and volition within the framework of the self-determination theory (SDT).
Collapse
|
43
|
Masson PC, Sheeshka JD. Clinicians' perspectives on the premature termination of treatment in patients with eating disorders. Eat Disord 2009; 17:109-25. [PMID: 19242841 DOI: 10.1080/10640260802714548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In-depth interviews concerning the premature termination of treatment (PTT) were conducted with seven clinicians in an inpatient eating disorders program. Motivation to be in the program and work on recovery, and the ability to establish a trusting relationship with staff were thought to be important factors in completing treatment. Patients who are asked to leave the treatment program, termed "administrative discharge" (AD), were believed by clinicians to differ from patients who dropped out of treatment in terms of having more reasons to stay in the program. While AD was described as a stressful process, particularly when there was disagreement among team members, it was considered necessary in order to maintain a recovery-centered community milieu. These findings, their implications and suggestions for future research are discussed.
Collapse
Affiliation(s)
- Philip C Masson
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | |
Collapse
|
44
|
Finzi-Dottan R, Zubery E. The role of depression and anxiety in impulsive and obsessive-compulsive behaviors among anorexic and bulimic patients. Eat Disord 2009; 17:162-82. [PMID: 19242845 DOI: 10.1080/10640260802714654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eating disorders are believed to range across a spectrum of varying degrees of obsessive-compulsive and impulsive behavior. Sixty anorexic (mean age = 19.8; sd = 5.9) and 109 bulimic (mean age = 26.9; sd = 11.3) female patients completed self-report questionnaires assessing obsessive-compulsiveness, impulsivity, depression and anxiety, as well as two eating disorder scales. Results yielded significantly higher levels of impulsivity and negative body image in the bulimic compared to the anorexic group. Regression analysis predicting impulsivity showed that bulimia and negative body image were the main contributors. Regression analysis for predicting obsessive-compulsive behavior suggested that depression and anxiety obscure the link between anorexia and obsessive-compulsive behavior, and a high BMI intensifies the association between anxiety and obsessive-compulsive behavior. The high rates of both impulsivity and obsessive-compulsiveness found in both groups, and their association with the severity of the eating disorder, may suggest that impulsivity and obsessive-compulsiveness are not mutually exclusive and can both be found among anorexic and bulimic patients.
Collapse
|
45
|
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.
Collapse
Affiliation(s)
- Beate Herpertz-Dahlmann
- Departments of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | | |
Collapse
|
46
|
Miotto P, Pollini B, Restaneo A, Favaretto G, Preti A. Aggressiveness, anger, and hostility in eating disorders. Compr Psychiatry 2008; 49:364-73. [PMID: 18555057 DOI: 10.1016/j.comppsych.2008.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 12/27/2007] [Accepted: 01/08/2008] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Despite evidence of a link between the behavioral and cognitive dimensions of aggressiveness and eating disorders, only few studies have tested this relation empirically. METHODS A total of 112 female patients with anorexia nervosa (n = 61) or bulimia nervosa (n = 51) and 631 young girls attending 7 high schools in the same health district as the patients (northeast Italy) were invited to fill in a set of self-report instruments including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test, and the Buss-Perry Aggression Questionnaire (AQ). RESULTS In both healthy controls and patients, scores on the measures of eating disorder symptoms were positively related to the scores on the AQ: the strength of the association did not differ between healthy controls and patients. However, patients diagnosed with eating disorders were not more likely to disclose a propensity to aggression than the healthy controls drawn from the community: patients with anorexia nervosa scored lower than controls on the physical aggression and on the verbal aggression subscales of the AQ (P < .05). On the other hand, patients with bulimia nervosa scored higher than controls on the anger subscale of the AQ (P < .05) but did not differ from them on the other subscales of the questionnaire. CONCLUSIONS The results confirm the higher propensity to anger in patients with bulimia nervosa; in patients with anorexia nervosa, difficulties in expressing anger and outward-directed aggressiveness can be a prevailing feature. The younger age of controls and exclusive reliance on self-report measures might have concealed some differences between patients and community subjects.
Collapse
Affiliation(s)
- Paola Miotto
- Eating Disorders Unit, Department of Mental Health, ULSS 7, Conegliano, TV, Italy
| | | | | | | | | |
Collapse
|
47
|
Personality dimensions and treatment drop-outs among eating disorder patients treated with cognitive behavior therapy. Psychiatry Res 2008; 158:381-8. [PMID: 18295903 DOI: 10.1016/j.psychres.2007.07.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 05/10/2007] [Accepted: 07/23/2007] [Indexed: 10/22/2022]
Abstract
Premature, unilateral interruption of inpatient treatment of eating disorders (ED) is a key factor limiting success. We evaluated the role of personality dimensions (temperament and character) in predicting drop-out in 145 consecutive ED inpatients (133 females) who entered cognitive behavior therapy. Baseline assessment included anthropometry, the Eating Disorder Examination, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Temperament and Character Inventory (TCI). Treatment was based on the new transdiagnostic cognitive behavior theory of ED, adapted for an inpatient setting; it was manual-based and lasted 20 weeks (13, inpatients; 7, residential day hospital). Thirty-four patients (23.4%) discontinued treatment. Drop-outs had a lower level of education, a higher prevalence of separation or divorce in the family, and lower scores on the TCI Persistence scale. After correction for age, gender and body-mass index, scores on the Persistence scale continued to be significantly related to drop-out, and the association was confirmed by Kaplan-Meier analysis. Eating disorder patients with low Persistence scores are significantly less likely to complete inpatient treatment.
Collapse
|
48
|
Treatment of anorexia nervosa: Insights and obstacles. Physiol Behav 2008; 94:113-20. [DOI: 10.1016/j.physbeh.2007.11.020] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 11/15/2007] [Indexed: 11/24/2022]
|
49
|
Halvorsen I, Heyerdahl S. Treatment perception in adolescent onset anorexia nervosa: retrospective views of patients and parents. Int J Eat Disord 2007; 40:629-39. [PMID: 17607715 DOI: 10.1002/eat.20428] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate perception of treatment in former patients with anorexia nervosa (AN) and their parents, and to determine whether this was related to outcome and treatment characteristics. Client satisfaction is important for treatment engagement and adherence. METHOD Forty-six (of 55) girls with adolescent onset AN, 33 mothers and 26 fathers participated in a follow-up study conducted 8.8 (SD 3.3) years after start of treatment. The former patients were assessed using diagnostic interviews. Only nine participants (19%) had an eating disorder (ED) at follow-up. Perception of treatment was assessed by questionnaires. RESULTS Parents reported having an overall positive perception of treatment. However, reports from former patients were significantly more negative than from the parents. In former patients, the "perception of therapists" total score and the items "therapists' knowledge of ED" and "usefulness of pediatric inpatient treatment" correlated with ED symptoms at follow-up. The perception of therapists' scores of the parents were not associated with the ED outcome of their daughters. More family therapy sessions were associated with the former patients' satisfaction with the therapists, while higher age at admission was associated with their mothers' satisfaction. CONCLUSION In spite of good ED outcome, former patients were only moderately satisfied with their treatment, whereas parental satisfaction was high.
Collapse
Affiliation(s)
- Inger Halvorsen
- Department of Child and Adolescent Psychiatry, Buskerud Hospital, Drammen, Norway.
| | | |
Collapse
|
50
|
Crane AM, Roberts ME, Treasure J. Are obsessive-compulsive personality traits associated with a poor outcome in anorexia nervosa? A systematic review of randomized controlled trials and naturalistic outcome studies. Int J Eat Disord 2007; 40:581-8. [PMID: 17607713 DOI: 10.1002/eat.20419] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Obsessive-compulsive personality disorder (OCPD) traits are commonly associated with anorexia nervosa (AN). The aim of this review was to systematically search the literature to examine whether OCPD traits have an impact on the outcome of AN. METHOD A systematic electronic search of the literature (using Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials) was undertaken to identify relevant publications (randomized controlled trials (RCT's) and naturalistic studies), until February 2006. RESULTS Eleven prospective longitudinal studies and 12 RCT's met criteria for inclusion. A meta-analysis was not feasible as the studies were too heterogeneous. Just over half of published longitudinal studies found that OCPD traits were associated with a negative outcome in AN. Additionally, results from three RCTs suggested that these traits may moderate outcome. OCPD traits were reduced after treatment in five RCTs. CONCLUSION There is tentative support to suggest that individuals with AN and concomitant OCPD traits have a poorer prognosis, and that these traits moderate outcome. A reduction in these traits may mediate this change. An individualized case formulation with treatment tailored to OCPD traits may improve the outcome of AN.
Collapse
Affiliation(s)
- Anna M Crane
- Eating Disorders Research Unit, Institute of Psychiatry, King's College, London, United Kingdom
| | | | | |
Collapse
|