1
|
Rienecke RD, Mehler PS, Duffy A, Le Grange D, Blalock DV. A brief examination of treatment outcomes in higher levels of care for individuals with eating disorders across age groups. EUROPEAN EATING DISORDERS REVIEW 2024; 32:431-439. [PMID: 38013216 DOI: 10.1002/erv.3054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Although eating disorders (EDs) occur throughout the lifespan, little research has been conducted with midlife/older adults, particularly those in higher levels of care (HLOC). The current study examined outcomes among 2009 patients with EDs receiving HLOC treatment at a large multisite facility between January 2020 and June 2022, across different age groups (ages <18, 18-25, 26-39 and ≥40). It was hypothesised that patients aged 40+ would exhibit less improvement on measures of ED psychopathology and depression than other age groups. METHOD Participants completed the eating disorder examination-questionnaire (EDE-Q) and the patient health questionnaire-9 (PHQ-9) at admission and discharge. RESULTS Changes for all outcomes from admission to discharge were statistically significant at p < 0.001 across all age groups. Changes in the EDE-Q Restraint subscale were significantly less in patients ages 26-39 than in patients ages 18-25 (p < 0.01). Changes in PHQ-9 were significantly greater in patients ages 40+ than patients ages 18-25 (p = 0.03). CONCLUSIONS Contrary to hypotheses, patients ages 40+ did not show worse outcomes than younger patients, and showed greater improvements in depression than young adults. The therapeutic needs of midlife/older adults with EDs may be favourably met by a HLOC regimen as described in this study.
Collapse
Affiliation(s)
- Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
- ACUTE at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, Colorado, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
2
|
Clark Bryan D, Rowlands K, Macdonald P, Cardi V, Ambwani S, Arcelus J, Landau S, Schmidt U, Treasure J. Transition support for patients admitted to intensive treatment for anorexia nervosa: qualitative study of patient and carer experiences of a hybrid online guided self-help intervention (ECHOMANTRA). BJPsych Open 2024; 10:e81. [PMID: 38623648 PMCID: PMC11060069 DOI: 10.1192/bjo.2023.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/08/2023] [Accepted: 12/06/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Adults with anorexia nervosa experience high levels of relapse following in-patient treatment. ECHOMANTRA is a novel online aftercare intervention for patients and carers, which provides psychoeducation and support to augment usual care. AIMS To explore patient and carer experiences of receiving the ECHOMANTRA intervention. METHOD This is part of the process evaluation of the ECHOMANTRA intervention as delivered in the TRIANGLE trial (ISRCTN: 14644379). Semi-structured interviews were conducted with 20 participants randomised to the ECHOMANTRA (ten patients and ten carers). Thematic analysis was used to analyse the interview transcripts. RESULTS Five major themes were identified: (1) Mixed experience of the intervention; (2) tailoring the intervention to the stage of recovery; (3) involvement of carers; (4) acceptability of remote support; and (5) impact of self-monitoring and accountability. CONCLUSIONS Participants were mostly positive about the support offered. The challenges of using remote and group support were counterbalanced with ease of access to information when needed. Components of the ECHOMANTRA intervention have the potential to improve care for people with eating disorders.
Collapse
Affiliation(s)
- Danielle Clark Bryan
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katie Rowlands
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Pamela Macdonald
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Valentina Cardi
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of General Psychology, University of Padova, Italy
| | - Suman Ambwani
- DIS Study Abroad in Scandinavia, Copenhagen, Denmark
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, UK; and Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Barcelona, Spain
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, King's College London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
3
|
Frank GKW, Stoddard JJ, Brown T, Gowin J, Kaye WH. Weight gained during treatment predicts 6-month body mass index in a large sample of patients with anorexia nervosa using ensemble machine learning. Int J Eat Disord 2024. [PMID: 38610100 DOI: 10.1002/eat.24208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE This study used machine learning methods to analyze data on treatment outcomes from individuals with anorexia nervosa admitted to a specialized eating disorders treatment program. METHODS Of 368 individuals with anorexia nervosa (209 adolescents and 159 adults), 160 individuals had data available for a 6-month follow-up analysis. Participants were treated in a 6-day-per-week partial-hospital program. Participants were assessed for eating disorder-specific and non-specific psychopathology. The analyses used established machine learning procedures combined in an ensemble model from support vector machine learning, random forest prediction, and the elastic net regularized regression with an exploration (training; 75%) and confirmation (test; 25%) split of the data. RESULTS The models predicting body mass index (BMI) at 6-month follow-up explained a 28.6% variance in the training set (n = 120). The model had good performance in predicting 6-month BMI in the test dataset (n = 40), with predicted BMI significantly correlating with actual BMI (r = .51, p = 0.01). The change in BMI from admission to discharge was the most important predictor, strongly correlating with reported BMI at 6-month follow-up (r = .55). Behavioral variables were much less predictive of BMI outcome. Results were similar for z-transformed BMI in the adolescent-only group. Length of stay was most predictive of weight gain in treatment (r = .56) but did not predict longer-term BMI. CONCLUSIONS This study, using an agnostic ensemble machine learning approach in the largest to-date sample of individuals with anorexia nervosa, suggests that achieving weight gain goals in treatment predicts longer-term weight-related outcomes. Other potential predictors, personality, mood, or eating disorder-specific symptoms were relatively much less predictive. PUBLIC SIGNIFICANCE The results from this study indicate that the amount of weight gained during treatment predicts BMI 6 months after discharge from a high level of care. This suggests that patients require sufficient time in a higher level of care treatment to meet their specific weight goals and be able to maintain normal weight.
Collapse
Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Joel J Stoddard
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tiffany Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Josh Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| |
Collapse
|
4
|
Maurel L, MacKean M, Lacey JH. Factors predicting long-term weight maintenance in anorexia nervosa: a systematic review. Eat Weight Disord 2024; 29:24. [PMID: 38582784 PMCID: PMC10998787 DOI: 10.1007/s40519-024-01649-5] [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] [Received: 10/19/2023] [Accepted: 03/03/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE Eating disorder recovery is a poorly defined concept, with large variations among researchers' definitions. Weight maintenance is a key aspect of recovery that remains relatively underexplored in the literature. Understanding the role of weight maintenance may help guide the development of treatments. This paper aims to address this by (1) investigating the factors predicting long-term weight maintenance in anorexia nervosa (AN) patients; (2) exploring differences in predictive factors between adolescent and adult populations; and (3) exploring how weight maintenance is conceptualised in the literature. METHODS We conducted a systematic review following PRISMA guidelines to address our research questions. Five databases were searched and filtered according to our exclusion criteria. RESULTS From the search, 1059 studies were yielded, and 13 studies were included for review. A range of weight, biological and psychological factors were found to predict weight maintenance among these papers. BMI at admission and discharge from inpatient treatment was the most common predictor among the papers. Few studies investigated biological factors and mixed evidence was found for psychological factors. We found no observable differences between adult and adolescent populations. Finally, weight maintenance was defined and measured differently across studies. CONCLUSION This review's findings can help contribute to a well-rounded understanding of weight maintenance, and ultimately, of recovery. This can help support clinicians in tailoring interventions to improve long-term outcomes in AN. Future research should aim to replicate studies to better understand the relationship between the factors identified and weight maintenance. LEVEL I Systematic review.
Collapse
Affiliation(s)
| | | | - J Hubert Lacey
- Schoen, Birmingham, UK.
- St George's, University of London, London, UK.
| |
Collapse
|
5
|
Sjögren M, Lichtenstein MB, Støving RK. Trauma Experiences Are Common in Anorexia Nervosa and Related to Eating Disorder Pathology but Do Not Influence Weight-Gain during the Start of Treatment. J Pers Med 2023; 13:jpm13050709. [PMID: 37240879 DOI: 10.3390/jpm13050709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The main characteristics of Anorexia Nervosa (AN) in adults are restriction of energy intake relative to requirements leading to significant weight loss, disturbed body image, and intense fear of becoming fat. Traumatic experiences (TE) have been reported as common, although less is known about the relationship with other symptoms in severe AN. We investigated the presence of TE, PTSD, and the relation between TE, eating disorder (ED) symptoms, and other symptoms in moderate to severe AN (n = 97) at admission to inpatient weight-restoration treatment. All patients were enrolled in the Prospective Longitudinal all-comer inclusion study on Eating Disorders (PROLED). METHODS TE were assessed using the Post-traumatic stress disorder checklist, Civilian version (PCL-C), and ED symptoms using the Eating Disorder Examination Questionnaire (EDE-Q); depressive symptoms were assessed using the Major Depression Inventory (MDI), and the presence of Post-traumatic Stress Disorder (PTSD) was diagnosed according to ICD-10 criteria. RESULTS The mean score on PCL-C was high (mean 44.6 SD 14.7), with 51% having a PCL-C score at or above 44 (n = 49, suggested cut-off for PTSD), although only one individual was clinically diagnosed with PTSD. There was a positive correlation between baseline scores of PCL-C and EDE-Q-global score (r = 0.43; p < 0.01) as well as of PCL-C and all EDE-Q subscores. None of the included patients were admitted for treatment of TE/PTSD during the first 8 weeks of treatment. CONCLUSIONS In a group of patients with moderate to severe AN, TE were common, and scores were high, although only one had a diagnosis of PTSD. TE were related to ED symptoms at baseline, but this association diminished during the weight restoration treatment.
Collapse
Affiliation(s)
- Magnus Sjögren
- Eating Disorder Research Unit, Psychiatric Center Ballerup, 2750 Ballerup, Denmark
- Institute for Clinical Science, Sundsvall Regional Hospital, Umeå University, 851 86 Sundsvall, Sweden
| | - Mia Beck Lichtenstein
- Center for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5230 Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, 5230 Odense, Denmark
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5230 Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, 5230 Odense, Denmark
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
| |
Collapse
|
6
|
Duck SA, Guarda AS, Schreyer CC. Parental dieting impacts inpatient treatment outcomes for adolescents with restrictive eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 36934407 DOI: 10.1002/erv.2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/13/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Parental feeding practices and disordered eating are potential risk factors for the development of disordered eating in children and adolescents. This study measured the relationship between parental dieting behaviours and inpatient treatment outcomes for adolescents with restrictive eating disorders (EDs). METHOD Parents of adolescents with restrictive EDs (N = 45) admitted to a specialty integrated inpatient-partial hospital meal-based ED treatment programme completed questionnaires assessing parental eating and exercise behaviours. Adolescent clinical data, including percentage median body mass index (%mBMI) at admission and discharge and rate of weight gain, were abstracted from the electronic medical record. RESULTS Adolescents whose parents reported dieting had a slower rate of weight gain (3.47 lbs./week) compared to participants whose parents were not dieting (4.54 lbs./week; p = 0.017). Additionally, participants whose parents reported dieting had a lower %mBMI at programme discharge (M = 93.56) than participants whose parents did not report dieting (M = 95.99; p = 0.033). CONCLUSION Parental dieting behaviours may impact an adolescent's response to inpatient ED treatment. Findings suggest a need to assess parental dieting behaviour, and when appropriate, provide additional psychoeducation regarding the potential risks of weight or shape-focussed dialogue and the benefits of modelling adaptive meal behaviours.
Collapse
Affiliation(s)
- Sarah Ann Duck
- Department of Psychological and Brain Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Steinberg DM, Perry TR, Freestone D, Hellner M, Baker JH, Bohon C. Evaluating differences in setting expected body weight for children and adolescents in eating disorder treatment. Int J Eat Disord 2023; 56:595-603. [PMID: 36458505 DOI: 10.1002/eat.23868] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Weight restoration or weight gain is a common goal in eating disorder treatment. However, approaches to determine expected body weight (EBW) vary. A standardized approach based on normative data for a patient's age and gender uses weight associated with median BMI (mBMI). An individualized approach predicts EBW based on a patient's individual growth trajectory. Little research has examined differences in these approaches. METHOD Weight and clinical data were collected from patients ages 6-20 enrolled in virtual eating disorder treatment. EBW associated with mBMI was compared with EBW using the individualized approach. Linear mixed effects models examined differences in weight, eating disorder symptoms, depression, and anxiety, and whether EBW approach varied by patient characteristics. RESULTS Patients (N = 609) were on average age 15.6 (2.29), 85% were cisgender female, and predominantly diagnosed with anorexia nervosa (83.1%). The individualized approach led to significantly higher EBW on average (mean difference = 8.4 lbs [SE: .75]; p < .001) compared to mBMI; 70% of patients had a higher EBW using the individualized approach. Notably, EBW varied based on gender and diagnosis and it took longer on average to achieve individualized EBW. Time was the strongest predictor of changes in psychosocial outcomes and there were no significant differences by EBW approach. DISCUSSION Results from this study indicate that an individualized approach led to significantly higher EBWs compared with using mBMI. As underestimation of EBW may lead to higher risk of relapse, eating disorder professionals should consider using an individualized approach for setting EBW. PUBLIC SIGNIFICANCE For eating disorder patients who need to gain weight, accurately estimating target body weight for eating disorder treatment is critical to recovery and preventing relapse. An individualized, patient-centered approach to estimating target body weight more accurately estimated target body weight than the standardized, median body mass index approach. Using an individualized approach to treatment may improve a patient's likelihood of full recovery.
Collapse
Affiliation(s)
- Dori M Steinberg
- Equip Health, Inc., Carlsbad, California, USA.,Duke University, Durham, North Carolina, USA
| | - Taylor R Perry
- Equip Health, Inc., Carlsbad, California, USA.,State University of New York at Albany, Albany, New York, USA
| | | | | | | | - Cara Bohon
- Equip Health, Inc., Carlsbad, California, USA.,Stanford University, Stanford, California, USA
| |
Collapse
|
8
|
Mehler PS, Anderson K, Bauschka M, Cost J, Farooq A. Emergency room presentations of people with anorexia nervosa. J Eat Disord 2023; 11:16. [PMID: 36759897 PMCID: PMC9909152 DOI: 10.1186/s40337-023-00742-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
People with anorexia nervosa (AN) tend to shy away from engaging in typical primary care provider relationships in order to avoid detection. Therefore, they may seek care for their medical concerns through a local emergency department (ED). Inherently, AN is associated with a litany of medical complications, which become more prevalent as the severity of their eating disorder increases. Notwithstanding the typical young age at the onset of AN, no body system is immune to these medical complications. Thus, ED providers may need to pursue a medical diagnosis in order to explain presenting symptoms in people with AN. In addition to the medical issues, AN is also a serious mental illness with high mortality rates, including deaths by suicide. Therefore, ED providers also need to be familiar with relevant mental health issues for these people.
Collapse
Affiliation(s)
- Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA. .,University of Colorado School of Medicine, Denver, CO, USA.
| | - Kristin Anderson
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeana Cost
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,Eating Recovery Center, Denver, CO, USA
| | - Asma Farooq
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Downs J, Ayton A, Collins L, Baker S, Missen H, Ibrahim A. Untreatable or unable to treat? Creating more effective and accessible treatment for long-standing and severe eating disorders. Lancet Psychiatry 2023; 10:146-154. [PMID: 36697122 DOI: 10.1016/s2215-0366(22)00400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 01/25/2023]
Abstract
The evidence base for the treatment of severe eating disorders is limited. In addition to improving access to early intervention, there is a need to develop more effective treatments for complex presentations of eating disorders. For patients with long-standing and severe illnesses, particular difficulties might exist with their engagement with treatment and achieving treatment outcomes. Alarmingly, there is an emerging international discourse about a concept labelled as terminal anorexia and about the withdrawal of treatment for people with severe eating disorders, resulting in the death of patients, as a legitimate option. This concept has arisen in the context of vastly overstretched specialist services and insufficient research and funding for new treatments. This Personal View combines multiple perspectives from carers, patients, and mental health professionals based in the UK, highlighting how the risks of current service provision are best alleviated by increasing resources, capacity, and training, and not by a narrowing of the criteria according to which patients with eating disorders are offered the care and support they need.
Collapse
Affiliation(s)
- James Downs
- Royal College of Psychiatrists, London, UK; Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK.
| | - Agnes Ayton
- Department of Psychiatry, Oxford University, Oxford, UK
| | | | | | | | | |
Collapse
|
10
|
Meule A, Kolar DR, Rauh E, Voderholzer U. Comparing illness duration and age as predictors of treatment outcome in female inpatients with anorexia nervosa. Eat Disord 2022; 31:274-284. [PMID: 36178330 DOI: 10.1080/10640266.2022.2114586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
It has been widely assumed that longer illness duration predicts poorer treatment outcome in persons with anorexia nervosa (AN). However, studies on the prognostic effects of illness duration have produced mixed results. Thus, the aim of the current study was to examine the relationship between illness duration and short-term treatment outcome in a large sample of female inpatients with AN (n = 902, aged 12-73 years). Treatment outcome variables included body mass index, therapist-rated global functioning (Global Assessment of Functioning scale and Clinical Global Impression-Improvement scale) and subscales of the Eating Disorder Inventory-2. Longer illness duration predicted smaller weight gain, smaller improvements in global functioning, and smaller decreases in self-reported eating disorder symptoms. However, illness duration was almost perfectly correlated with patients' age (r = .81, 95% CI [.76, .85]), and comparing regression models revealed that models using either illness duration or age were indistinguishable. Results suggest that longer illness duration does indeed relate to worse short-term treatment outcome in inpatients with AN. This effect, however, does not add significant information above and beyond patients' age and, thus, the importance of illness duration for anticipating treatment outcome both in research and in clinical practice must be critically examined.
Collapse
Affiliation(s)
- Adrian Meule
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - David R Kolar
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Elisabeth Rauh
- Schoen Clinic Bad Staffelstein, Bad Staffelstein, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| |
Collapse
|
11
|
Reay M, Holliday J, Stewart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorders. J Eat Disord 2022; 10:128. [PMID: 36038898 PMCID: PMC9421634 DOI: 10.1186/s40337-022-00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery rates for people with eating disorders are low; fewer than half recover and approximately 20% develop a longstanding eating disorder. Patients with longstanding eating disorders are often referred to as "SEED" (severe and enduing eating disorders) although this remains controversial and is not acknowledged in the British treatment guidance. This project aimed to generate recommendations for a longstanding eating disorder care pathway by identifying what proportion of patients have longstanding eating disorders and how to best identify and support them. METHODS Initially, a literature review was completed, followed by interviews with service-users who consider themselves to have longstanding eating disorders, and focus groups with staff members. The results were combined to create a definition of a longstanding eating disorder which was used to establish how many service-users could benefit from the pathway. The qualitative data was used to produce recommendations for a tailored pathway for those with longstanding eating disorders. RESULTS The results highlighted that, although "SEED" is often used, participants preferred to be referred to as "longstanding" or having no label. Qualitative analysis identified four themes in relation to supporting this population group which described how to structure the service and individualise care, as well as patients' relationship to the service, and how to build a life after eating disorder services. CONCLUSIONS Recommendations included promoting a hopeful message, focusing on quality of life and introducing peer support. Crucially, accessing the pathway should not result in being labelled "SEED", nor should it prevent access to recovery focused interventions including weight restoration. The full list of recommendations are included as well as the implications of the project and limitations.
Collapse
Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | | | - Joanna Adams
- The Oxford Institute for Clinical Psychology Training and Research, Oxford, UK
| |
Collapse
|
12
|
Ibrahim A, Ryan S, Viljoen D, Tutisani E, Gardner L, Collins L, Ayton A. Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings. J Eat Disord 2022; 10:98. [PMID: 35804403 PMCID: PMC9264571 DOI: 10.1186/s40337-022-00620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Inpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice. METHODS This is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6-8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay. RESULTS 212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18-60) years, mean admission BMI was 14.1 (10-18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ2 < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU. CONCLUSIONS Our main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.
Collapse
Affiliation(s)
- Ali Ibrahim
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sharon Ryan
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | | | | | - Lorna Collins
- Oxford Health NHS Foundation Trust, Oxford, UK.,Arts and Sciences, University College London, London, UK
| | - Agnes Ayton
- Oxford Health NHS Foundation Trust, Oxford, UK. .,Department of Psychiatry, University of Oxford, Oxford, UK.
| |
Collapse
|
13
|
Guarda AS, Hanson A, Mehler P, Westmoreland P. Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined. J Eat Disord 2022; 10:79. [PMID: 35672780 PMCID: PMC9175496 DOI: 10.1186/s40337-022-00599-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022] Open
Abstract
A recent article (JED 10:23, 2022) proposed defining terminal anorexia to improve access to palliative and hospice care, and to medical aid in dying for a minority of patients with severe and enduring anorexia nervosa (SE-AN). The authors presented three cases and, for two, the first author participated in their death. Anorexia nervosa is a treatable psychiatric condition for which recovery may be uncertain. We are greatly concerned however regarding implications of applying the label "terminal" to anorexia nervosa and the risk it will lead to unjustified deaths in individuals whose mental illness impairs their capacity to make a reasoned treatment decision.
Collapse
Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA.
| | - Annette Hanson
- Department of Psychiatry, University of Maryland, Jessup, MD, 20794, USA
| | - Philip Mehler
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patricia Westmoreland
- Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, 80045, USA
| |
Collapse
|
14
|
BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review. J Pers Med 2022; 12:jpm12050836. [PMID: 35629258 PMCID: PMC9144864 DOI: 10.3390/jpm12050836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, there is insufficient knowledge on the predictors of relapse after weight normalization and this is why a systematic literature review was performed. Methods: PubMed, EMBASE, PsychInfo, and Cochrane databases were searched for literature published until 13 July 2021. All study designs were eligible for inclusion if they focused on predictors of relapse after weight normalization in AN. Individual study definitions of relapse were used, and in general, this was either a drop in BMI and/or reccurrence of AN symptoms. Results: The database search identified 11,507 publications, leaving 9511 publications after the removal of duplicates and after a review of abstracts and titles; 191 were selected for full-text review. Nineteen publications met the criteria and included 1398 AN patients and 39 healthy controls (HC) from adults and adolescents (ages range 11–73 years). The majority used a prospective observational study design (12 studies), a few used a retrospective observational design (6 studies), and only one was a non-randomized control trial (NRCT). Sample sizes ranged from 16 to 191 participants. BMI or measures of body fat and leptin levels at discharge were the strongest predictors of relapse with an approximate relapse rate of 50% at 12 months. Other predictors included signs of eating disorder psychopathology at discharge. Conclusions: BMI at the end of treatment is a predictor of relapse in AN, which is why treatment should target a BMI well above 20. Together with the time to relapse, these outcomes are important to include in the evaluation of current and novel treatments in AN and for benchmarking.
Collapse
|
15
|
Sjögren M, Støving RK. Anorexia Nervosa: Reduction in Depression during Inpatient Treatment Is Closely Related to Reduction in Eating Disorder Psychopathology. J Pers Med 2022; 12:jpm12050682. [PMID: 35629105 PMCID: PMC9145215 DOI: 10.3390/jpm12050682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Anorexia nervosa (AN) is a severe mental disorder frequently associated with high scores of depressiveness. We examined the short-term effects of inpatient treatment on depressiveness and eating disorder (ED) psychopathology using the self-rating Major Depression Inventory (MDI) and Eating Disorder Examination questionnaire (EDEq) for patients with AN. Material: Forty-nine patients with AN, all part of the PROspective Longitudinal all-comer inclusion study on EDs (PROLED), were observed over eight weeks with baseline psychometric measures, EDE-q at baseline and endpoint, and weekly MDI self-scoring. Methods: Apart from the weekly Body Mass Index (BMI) measurements, patients were assessed at baseline using the Eating Disorder Inventory (EDI) and the Symptom Check List 92 (SCL-92). Results: Inpatient treatment reduced MDI consistently over 8 weeks (Wilks Lambda = 0.59, F = 4.1, p < 0.01) and this reduction in MDI was positively correlated with a reduction in EDEq (r = 0.44; p < 0.01) during inpatient treatment. Baseline medication did not predict changes in MDI during the inpatient treatment. BMI increased from 14.9 (week 1) to 17.2 (week 8). Conclusions: Inpatient treatment of AN is associated with a reduction in depressiveness. This improvement in depressiveness scores correlates with an improvement in ED psychopathology but not with weight gain.
Collapse
Affiliation(s)
- Magnus Sjögren
- Psychiatric Center Ballerup, 2750 Ballerup, Denmark
- Institute for Clinical Science, Umeå University, 90185 Umeå, Sweden
- Correspondence:
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, 5000 Odense, Denmark;
- Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| |
Collapse
|
16
|
Ayton A, Viljoen D, Ryan S, Ibrahim A, Ford D. Risk, demand, capacity and outcomes in adult specialist eating disorder services in South-East of England before and since COVID-19. BJPsych Bull 2022; 46:89-95. [PMID: 34486966 PMCID: PMC9074142 DOI: 10.1192/bjb.2021.73] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD This is a longitudinal cohort study describing the demand, capacity and outcomes of adult specialist eating disorder in-patient services covering a population of 3.5 million in a South-East England provider collaborative before and since the COVID-19 pandemic, between July 2018 and March 2021. RESULTS There were 351 referrals for admission; 97% were female, 95% had a diagnosis of anorexia nervosa and 19% had a body mass index (BMI) <13. Referrals have increased by 21% since the start of pandemic, coinciding with reduced capacity. Waiting times have increased from 33 to 46 days. There were significant differences in outcomes between providers. A novel, integrated enhanced cognitive behaviour theapy treatment model showed a 25% reduction in length of stay and improved BMI on discharge (50% v. 16% BMI >19), compared with traditional eclectic in-patient treatment. CLINICAL IMPLICATIONS Integrated enhanced cognitive behaviour theapy reduced length of stay and improved outcomes, and can offer more effective use of healthcare resources.
Collapse
Affiliation(s)
| | | | | | - Ali Ibrahim
- Berkshire Eating Disorder Service, Berkshire NHS Foundation Trust, UK
| | | |
Collapse
|
17
|
Webb H, Dalton B, Irish M, Mercado D, McCombie C, Peachey G, Arcelus J, Au K, Himmerich H, Louise Johnston A, Lazarova S, Pathan T, Robinson P, Treasure J, Schmidt U, Lawrence V. Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings. J Eat Disord 2022; 10:3. [PMID: 34991715 PMCID: PMC8733908 DOI: 10.1186/s40337-021-00528-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Admissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians' perspectives and experience of supporting adults with severe AN in intensive settings. METHODS We conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software. RESULTS Five broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients' Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients' home environments, the necessity of patient motivation, and the management of risk. CONCLUSIONS Both intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research.
Collapse
Affiliation(s)
- Hannah Webb
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Bethan Dalton
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Madeleine Irish
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Daniela Mercado
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gemma Peachey
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | | | | | - Tayeem Pathan
- Surrey and Boarder Partnership NHS Foundation Trust, Surrey, UK
| | - Paul Robinson
- Division of Medicine, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Vanessa Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
18
|
Ali AM, Hori H, Kim Y, Kunugi H. Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain. Front Psychiatry 2021; 12:735109. [PMID: 34899416 PMCID: PMC8663168 DOI: 10.3389/fpsyt.2021.735109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023] Open
Abstract
Eating disorders (EDs) are a complex group of psychiatric conditions that involve dysfunctional eating patterns, nutritional alterations, and other comorbid psychopathologies. Some women with EDs may develop problematic internet use while they attempt to get information on dieting/weight control or get online support from people with similar problems. They may also drift toward tobacco smoking as a method to regulate their weight or to cope with their weight-related dysphoria. The occurrence of these conditions in EDs may prolong disease course and impede recovery. This study used structural equation modeling to investigate nutritional status (noted by body mass index, BMI), depression psychopathology, internet addiction (depicted by the Internet Addiction Test), Facebook addiction (depicted by the Bergen Facebook Addiction Scale), and smoking among 123 Spanish women diagnosed with EDs (mean age = 27.3 ± 10.6 years). History of hospitalization, marital status, age, and the level of education predicted BMI in certain ED groups. BMI did not predict depression, but it predicted internet addiction, Facebook addiction, and smoking in certain ED groups. Depression did not predict BMI, internet/Facebook addition, or smoking in any ED group. Some sociodemographic and clinical variables had indirect effects on depression, internet addiction, and Facebook addiction while age was the only variable expressing a direct effect on all outcome measures. Age, education, and history of prolonged treatment predicted smoking in certain ED patients. The findings signify that a considerable target for interventional strategies addressing nutritional and addictive problems in EDs would be women with high BMI, history of hospitalization, history of prolonged treatment, who are particularly young, single, and less educated. Replication studies in larger samples, which comprise various subtypes of EDs from both genders, are warranted to define the exact interaction among the addressed variables.
Collapse
Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
19
|
Inpatient Weight Restoration Treatment Is Associated with Decrease in Post-Meal Anxiety. J Pers Med 2021; 11:jpm11111079. [PMID: 34834431 PMCID: PMC8621034 DOI: 10.3390/jpm11111079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Anorexia nervosa (AN) is characterized by weight loss, distorted body image with fear of becoming fat and associated with anxiety, especially in relation to food intake. Anxiety in relation to meals and weight restoration remains a major challenge in the treatment of AN. We examined the effects of inpatient weight restoration treatment on levels of post-meal anxiety using visual analogue scale (VAS) ratings in patients with AN. Materials: Thirty-two patients with AN, all part of the PROspective Longitudinal all-comer inclusion study on Eating Disorders (PROLED) were followed over eight weeks with baseline psychometric measures and weekly VAS anxiety self-scoring. Methods: Apart from the weekly body mass index (BMI) and VAS, patients were characterized at baseline using the Eating Disorder Examination Questionnaire (EDE-Q), Eating Disorder Inventory (EDI), Symptom Check List 92 (SCL-92), Major Depression Inventory (MDI), and Autism Quotient (AQ). Results: The results showed a significant time effect, Wilks Lambda = 0.523, F = 3.12, p < 0.05 (power of 0.862), indicating a reduction in VAS scores of anxiety from baseline to week 8. There was no effect of baseline medication or scores of MDI on the results. BMI increased from a mean of 15.16 (week 1) to 17.35 (week 8). In comparison, patients dropping out after only three weeks (n = 31) also had a trend toward a reduction in VAS anxiety (ns). Conclusions: Inpatient weight restoration treatment is associated with a decrease in post-meal anxiety in AN, an effect that occurs early and becomes clinically significant in patients who stay in treatment.
Collapse
|
20
|
Duriez P, Nilsson IAK, Le Thuc O, Alexandre D, Chartrel N, Rovere C, Chauveau C, Gorwood P, Tolle V, Viltart O. Exploring the Mechanisms of Recovery in Anorexia Nervosa through a Translational Approach: From Original Ecological Measurements in Human to Brain Tissue Analyses in Mice. Nutrients 2021; 13:nu13082786. [PMID: 34444945 PMCID: PMC8401511 DOI: 10.3390/nu13082786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder where caloric restriction, excessive physical activity and metabolic alterations lead to life-threatening situations. Despite weight restoration after treatment, a significant part of patients experience relapses. In this translational study, we combined clinical and preclinical approaches. We describe preliminary data about the effect of weight gain on the symptomatology of patients suffering from acute AN (n = 225) and partially recovered (n = 41). We measured more precisely physical activity with continuous cardiac monitoring in a sub-group (n = 68). Using a mouse model, we investigated whether a long-term food restriction followed by nutritional recovery associated or not with physical activity may differentially impact peripheral and central homeostatic regulation. We assessed the plasma concentration of acyl ghrelin, desacyl ghrelin and leptin and the mRNA expression of hypothalamic neuropeptides and their receptors. Our data show an effect of undernutrition history on the level of physical activity in AN. The preclinical model supports an important role of physical activity in the recovery process and points out the leptin system as one factor that can drive a reliable restoration of metabolic variables through the hypothalamic regulation of neuropeptides involved in feeding behavior.
Collapse
Affiliation(s)
- Philibert Duriez
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- GHU Paris Psychiatry and Neurosciences, Hospital Sainte-Anne, F-75014 Paris, France
| | - Ida A. K. Nilsson
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Centre for Eating Disorders Innovation (CEDI), Medical University, Karolinska Institutet, S-17176 Stockholm, Sweden;
| | - Ophelia Le Thuc
- CNRS UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), University of Nice-Sophia Antipolis, F-06560 Valbonne, France; (O.L.T.); (C.R.)
| | - David Alexandre
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Normandie, UNIROUEN, F-76821 Mont-Saint-Aignan, France; (D.A.); (N.C.)
| | - Nicolas Chartrel
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Normandie, UNIROUEN, F-76821 Mont-Saint-Aignan, France; (D.A.); (N.C.)
| | - Carole Rovere
- CNRS UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), University of Nice-Sophia Antipolis, F-06560 Valbonne, France; (O.L.T.); (C.R.)
| | - Christophe Chauveau
- Marrow Adiposity and Bone Laboratory (MABLab), University of Littoral Côté d’Opale, CHRU Lille, F-62327 Boulogne sur Mer, France;
- Faculty of Sciences and Technologies, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- GHU Paris Psychiatry and Neurosciences, Hospital Sainte-Anne, F-75014 Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- Faculty of Sciences and Technologies, University of Lille, F-59650 Villeneuve d’Ascq, France
- Correspondence: ; Tel.: +33-6-76-88-05-06
| |
Collapse
|
21
|
Kaufmann LK, Moergeli H, Milos GF. Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome. Front Psychiatry 2021; 12:682952. [PMID: 34335330 PMCID: PMC8319499 DOI: 10.3389/fpsyt.2021.682952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favorable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome. Methods: We included 107 patients aged 17-56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1-6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients' age, sex, and duration of illness. Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI. Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.
Collapse
Affiliation(s)
- Lisa-Katrin Kaufmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Gabriella Franca Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|