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Latest Research on Anorexia
   
J Adolesc Health. 2008 Feb;42(2):111-118.
Clinical Efficacy and Safety of Parenteral Nutrition in Adolescent Girls with Anorexia Nervosa.
Diamanti A, Basso MS, Castro M, Bianco G, Ciacco E, Calce A, Caramadre AM, Noto C, Gambarara M.
Gastroenterology and Nutrition Unit, Children’s Hospital “Bambino Gesù”, Rome, Italy.

PURPOSE: Anorexia nervosa (AN) is a common chronic disorder characterized by severe malnutrition and psychological disturbances. Parenteral nutrition (PN) is not usually used in nutritional rehabilitation of AN. The aim of our study was to retrospectively evaluate the indications, clinical efficacy, and safety of PN as assessed by short- and long-term outcomes in AN inpatient girls. METHODS: During the last 10 years a total of 198 inpatients were included in our study: 104 (53%) received oral and parenteral refeeding (group A) and 94 (47%) oral refeeding alone (group B). For each nutritional treatment, clinical efficacy was evaluated by short- and long-term outcomes, and safety was assessed by complication rate. RESULTS: Short-term outcome assessment indicated weekly weight gain and maximum caloric intake to be higher in PN-treated patients. Long-term outcome evaluation showed rehospitalization and recovery rate to be similar in the two groups, but failure of first nutritional rehabilitation requiring PN significantly greater in group B (17.5%) than in group A (3%) (p = .01). The number of complications was significantly higher in group A than in group B (p = .004), although all complications resolved. CONCLUSION: Among all nutritional rehabilitation strategies, PN offers an alternative and safe way to successfully treat AN patients. Presence of clinical complications and reduced compliance with individual, group, and family therapy seem to be the main indications for PN, as it promptly improves nutritional status. At pediatric and adolescent ages, psychological disturbances can also contraindicate the use of enteral nutrition, and therefore represent an additional indication for PN.

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Eat Disord. 2008 Jan-Feb;16(1):40-51.
Support for parents of children with anorexia: what parents want.
Honey A, Boughtwood D, Clarke S, Halse C, Kohn M, Madden S.
University of Western Sydney, Sydney, Australia.

Parents' encounters with health professionals can influence their ability to cope with having a daughter with anorexia nervosa. Using qualitative analysis of in-depth interviews with 24 parents, we examine the question "What support do parents of teenage girls with anorexia want from clinicians?" The analysis shows that parents wanted clinicians to include them in treatment, support and guide them in their daughters' care, and demonstrate positive attitudes toward them. The implications for clinicians are discussed, including being sensitive to parents' vulnerability, ensuring congruence between clinicians' and parents' expectations about treatment, and strengthening formal channels of communication.

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Physiol Behav. 2007 Nov 22 [Epub ahead of print]
Treatment of anorexia nervosa: Insights and obstacles.
Guarda AS.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.

Anorexia nervosa is a behavioral disorder characterized by ego-syntonic self-starvation, denial of illness and ambivalence towards treatment. Treatment refusal and drop-out rates are high and relapse is common. Treatment is best viewed as comprised of two phases, weight restoration and normalization of eating behavior followed by relapse prevention. Most patients verbalize a desire to change, however they seek treatment on their own terms, ideally with minimal or no weight gain. Successful treatment must therefore convince patients to overcome their drive to diet. Evidence-based data on treatment interventions for anorexia nervosa are scarce and methodological problems afflict the few published, controlled trials. Taken together, clinical expertise and data from correlational and controlled trials suggest that chronicity and adult status are associated with a worse prognosis. Outpatient family therapy is effective in weight-restoring the majority of adolescent patients whereas older patients, or those with severe medical or psychiatric comorbidity, often require intensive treatment on an inpatient eating disorders behavioral specialty unit. Correlational data suggest that weight-restored patients are less likely to relapse. Despite limitations of the current knowledge-base, several new areas of research hold promise in elucidating risk factors, in identifying the pathophysiology that sustains anorectic behavior, and in developing more targeted and effective treatments.

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Eur Eat Disord Rev. 2007 Nov 14 [Epub ahead of print]
Atypical antipsychotics in severe anorexia nervosa in children and adolescents-review and case reports.
Mehler-Wex C, Romanos M, Kirchheiner J, Schulze UM.
Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, Ulm, Germany.

OBJECTIVE: To review the literature on the use of atypical antipsychotics in anorexia nervosa of children and adolescents and to present three case reports on quetiapine treatment of this subgroup. METHOD: Review of the literature and case report. RESULTS: Several case reports and two small open-label trials, mainly in adults, observed beneficial effects of olanzapine on anorexic psychopathology. Only 16 case reports have been published on children and adolescents. Because of its lower propensity to induce weight gain quetiapine might be favourable with regard to patients' compliance. Our case reports revealed positive psychopathological effects and good tolerability of quetiapine in minors with severe anorexia nervosa. Careful titration and intense drug monitoring are recommended. DISCUSSION: In a small subset of patients with severe, treatment- resistant anorexia nervosa, extreme weight phobia, delusional body image disturbances or severe hyperactivity might be considered as indications for atypical antipsychotics. However, controlled studies are needed. Copyright (c) 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

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Child Psychiatry Hum Dev. 2007 Nov 7 [Epub ahead of print]
Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa.
Salbach-Andrae H, Lenz K, Simmendinger N, Klinkowski N, Lehmkuhl U, Pfeiffer E.
Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Charité, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany, harriet.salbach@charite.de.

This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN.

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Curr Opin Obstet Gynecol. 2007 Oct;19(5):434-9.
Eating disorders in adolescence: what is the role of hormone replacement therapy?
Golden NH.
Division of Adolescent Medicine, Lucile Packard Children's Hospital at Stanford, Mountain View, California 94040, USA. ngolden@stanford.edu

PURPOSE OF REVIEW: To review the diagnostic criteria and clinical presentation of eating disorders in adolescence, to outline an approach to treatment, and examine evidence for prescribing hormone replacement therapy to increase bone mineral density in anorexia nervosa. RECENT FINDINGS: Eating disorders are prevalent in adolescents and can present with amenorrhea and menstrual disturbances. Reduced bone mineral density leading to osteoporosis and increased fracture risk is a frequent, severe, and potentially irreversible complication of anorexia nervosa. The degree of bone mineral density reduction depends on the duration of amenorrhea and degree of malnutrition. Limited evidence supports the use of hormone replacement therapy to increase bone mineral density in adolescents with anorexia nervosa. SUMMARY: In adolescents with amenorrhea or menstrual disturbances, the gynecologist should consider the possibility of an eating disorder. The diagnosis can be made on history and physical examination. If an eating disorder is suspected, the patient should be referred for evaluation and treatment. Support for the use of hormone replacement therapy to increase bone mineral density in adolescents with anorexia nervosa is limited, and its routine use should be discouraged. Weight restoration, calcium and vitamin D supplementation and the resumption of spontaneous menses is the mainstay of treatment.

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Aust Fam Physician. 2007 Aug;36(8):614-9.
Eating disorders in adolescents.
Gonzalez A, Kohn MR, Clarke SD.
MBBS, is Fellow in Adoelscent Medicine, Centre for Research into Adolescents' Health (CRASH), Department of Adoelscent Medicine, Westmead Hospital, New South Wales.

BACKGROUND: The overall prevalence of eating disorders among children and adolescents is rising - the younger age group are more likely to present with anorexia nervosa (AN), while the older adolescent can present with either AN or bulimia nervosa (BN). However, eating disorders exist as part of a spectrum and general practitioners will encounter many adolescents that have an eating disorder that do not yet fulfil diagnostic criteria for either AN or BN. OBJECTIVE: This article aims to provide an overview of assessment and principles of management of eating disorders in the adolescent patient. DISCUSSION: General practitioners are key in recognising and offering early intervention in cases of incipient eating disorders or problem dieting behaviour. The physical findings of AN are those of protein calorie malnutrition, while in BN, they reflect chronic purging. Failure of outpatient management requires hospitalisation for nutritional rehabilitation with close monitoring of fluid and electrolyte status to prevent the development of refeeding syndrome. Family involvement is vital, particularly in the younger patient, with ongoing family therapy offering the best outcomes.

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Eur Eat Disord Rev. 2007 Jul;15(4):275-82.
Premature termination of treatment in an inpatient eating disorder programme.
Masson PC, Perlman CM, Ross SA, Gates AL.
Homewood Health Centre, Guelph, Ontario, Canada.

This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed. 2006 John Wiley & Sons, Ltd and Eating Disorders Association

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J Psychiatr Pract. 2007 Jul;13(4):238-245.
The Application of Exposure Therapy and D-Cycloserine to the Treatment of Anorexia Nervosa: A Preliminary Trial.
Steinglass J, Sysko R, Schebendach J, Broft A, Strober M, Walsh BT.
STEINGLASS, SCHEBENDACH, BROFT, and WALSH: College of Physicians & Surgeons of Columbia University, and New York State Psychiatric Institute; SYSKO: College of Physicians & Surgeons of Columbia University, New York State Psychiatric Institute, and Rutgers University; STROBER: Semel Institute of Neuroscience & Human Behavior, and Resnick UCLA Neuropsychiatric Hospital, David Geffen School of Medicine at UCLA.

OBJECTIVE.: Novel approaches to the treatment of anorexia nervosa (AN) are needed. This preliminary study examined the utility and safety of an exposure therapy intervention and D-cycloserine (DCS) in a population of patients with AN. METHOD.: Eleven participants completed a series of 6 laboratory meals, including pre- and post-exposure test meals and four exposure sessions. Participants were randomly assigned to receive either DCS or placebo in double-blind fashion before each of the 4 exposure sessions. These results were compared to data from a previously studied group of patients who received treatment as usual. RESULTS.: Total caloric intake increased significantly from the baseline meal session to the post-test meal session in the patients who received the exposure therapy intervention. Caloric intake did not increase significantly in the comparison group. CONCLUSION.: These data suggest that an exposure therapy intervention specifically focused on meal consumption may
be helpful in increasing intake of a test meal.

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Am J Clin Nutr. 2007 Jul;86(1):92-9.
Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses.
Dominguez J, Goodman L, Sen Gupta S, Mayer L, Etu SF, Walsh BT, Wang J, Pierson R, Warren MP.
Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.

BACKGROUND: Recovery from osteoporosis in anorexia nervosa (AN) is uncertain. OBJECTIVE: The purpose of this study was to understand the changes in bone mineral density (BMD) in women with AN and the mechanisms of recovery from osteopenia. DESIGN: We studied BMD and markers of bone formation and resorption, osteocalcin and N-telopeptide (NTX), in patients with AN (n=28) who were following a behavioral weight-gain protocol. RESULTS: Anorexic patients experienced significant percentage increases in BMD (4.38 +/- 7.48% for spine; 3.77 +/- 8.8% for hip; P<0.05 for both) from admission until recovery of 90% ideal body weight, achieved over 2.2 mo. NTX concentrations were higher in patients with AN at admission than in healthy control subjects (n=11; 69.0 +/- 31.09 and 48.3 +/- 14.38 nmol/mmol creatinine, respectively; P<0.05) and in reference control subjects (n=30; 69.0 +/- 31.09 and 37.0+/-6.00 nmol/mmol creatinine, respectively; P<0.001). In weight-recovered subjects with AN, osteocalcin increased (from 8.0 +/- 3.05 to 11.2 +/- 6.54 ng/mL; P<0.05), whereas NTX remained elevated (from 69.0 +/- 31.09 to 66.7 +/- 45.5 nmol/mmol creatinine; NS). A decrease in NTX (from 70.7 +/- 40.84 to 45.9 +/- 22.72 nmol/mmol creatinine; NS) occurred only in the subgroup of subjects who regained menses with weight recovery. CONCLUSIONS: Nutritional rehabilitation induces a powerful anabolic effect on bone. However, a fall of NTX and a shift from the dominant resorptive state, which we postulate involves full recovery, may involve a hormonal mechanism and require a return of menses. Nutritional rehabilitation appears to be critical to bone recovery and may explain the ineffectiveness of estrogen treatment alone on BMD in the cachectic state.

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J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):792-800.
Open trial of family-based treatment for full and partial anorexia nervosa in adolescence: evidence of successful dissemination.
Loeb KL, Walsh BT, Lock J, le Grange D, Jones J, Marcus S, Weaver J, Dobrow I.
Mount Sinai School of Medicine, New York, NY 10029, USA. katharine.loeb@mssm.edu

OBJECTIVE: There is a paucity of evidence-based interventions for anorexia nervosa (AN). An innovative family-based treatment (FBT), developed at the Maudsley Hospital and recently put in manual form, has shown great promise for adolescents with AN. Unlike traditional treatment approaches, which promote sustained autonomy around food, FBT temporarily places the parents in charge of weight restoration. This aim of this open trial was to investigate the feasibility and effectiveness of delivering FBT at a site beyond the treatment's origin and manualization. METHOD: Twenty adolescents (ages 12-17) with AN or subthreshold AN were treated with up to 1 year of FBT using the published treatment manual. Outcome indices included the percentage of ideal body weight, menstrual status, the Eating Disorder Examination (EDE) subscales scores, and the Children's Depression Rating Scale-Revised score. RESULTS: Of the 20 patients recruited, 15 (75%) completed a full course of treatment. Inte
nt-to-treat analyses showed significant improvement over time in the percentage of ideal body weight (t = -4.46, p =.000), menstrual status (p =.002), EDE Restraint (z = -3.02, p =.003), EDE Eating Concern (z = -2.10, p =.04), but not in EDE Shape Concern or Weight Concern subscales or Children's Depression Rating Scale-Revised score. CONCLUSIONS: This open trial provides evidence that FBT can be successfully disseminated, replicating the high retention rates and significant improvement in the psychopathology of adolescent AN seen at the original sites.

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Int J Clin Exp Hypn. 2007 Jul;55(3):318-35.
Efficacy of hypnotherapy in the treatment of eating disorders.
Barabasz M.
Washington State University, Pullman, Washington 99164-2136, USA. mbarabasz@wsu.edu

Research on the efficacy of hypnosis in the treatment of eating disorders has produced mixed findings. This is due in part to the interplay between the characteristics of people with eating disorders and the phenomena of hypnosis. In addition, several authors have noted that methodological limitations in hypnosis research often make evaluation of treatment efficacy difficult. Many of the studies extant provide insufficient information regarding the specifics of the hypnotic intervention(s) to facilitate replication and clinical implementation. Therefore, this paper only reviews literature with replicable methodological descriptions. It focuses on the three primary disorders of interest to clinicians: bulimia nervosa, anorexia nervosa, and obesity. The implications for evaluating treatment efficacy are discussed.

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Curr Opin Psychiatry. 2007 Jul;20(4):315-8.
Does the treatment of mental disorders in childhood lead to a healthier adulthood?
Hazell P.

PURPOSE OF REVIEW: To review mechanisms by which intervention for childhood mental disorders may exert an influence on mental health and wellbeing in adulthood, the challenges to demonstrating long-term benefit or harm from such intervention, existing evidence of long-term benefit, and strategies for improving the long-term benefit of treatment. RECENT FINDINGS: Intervention may improve long-term outcome through the promotion of protective interpersonal relationships, by enhancing scholastic and later occupational functioning, by arresting the progression of disorder, and by improving general health. Challenges to demonstrating benefits or harms in the long term include variability in the natural course of childhood mental disorders, heterotypic outcomes, and the influence of other variables over time on long-term functioning. Examples of demonstrated benefit include the lowering of risk for substance abuse seen with psychostimulant treatment for attention-deficit/hyperactivity disorder, improved outcomes for autism since the introduction of early interventions to address language impairment, and reduced mortality in anorexia nervosa. SUMMARY: There are feasible enduring benefits of treatment for childhood mental disorders. Treatment of complex problems may have a greater long-term impact than in conditions that follow a benign natural course. Success requires more assertive approaches to treatment than are traditionally employed by child and adolescent mental health services.

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J Child Psychol Psychiatry. 2007 Jun;48(6):552-60.
A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up.
Eisler I, Simic M, Russell GF, Dare C.
South London and Maudsley NHS Trust, London, UK. i.eisler@iop.kcl.ac.uk

BACKGROUND: There is growing evidence that family therapy is an effective treatment for adolescent anorexia nervosa. This study aimed to ascertain the long-term impact of two forms of outpatient family intervention previously evaluated in a randomised controlled trial (RCT). METHOD: A five-year follow-up was conducted on a cohort of 40 patients who had received either 'conjoint family therapy' (CFT) or 'separated family therapy' (SFT). All patients were traced and 38 agreed to be reassessed (29 interviewed in person, 3 completed telephone interviews, 6 completed questionnaires and/or agreed for parents/GP to be interviewed). RESULTS: Overall there was little to distinguish the two treatments at 5 years, with more than 75% of subjects having no eating disorder symptoms. There were no deaths in the cohort and only 8% of those who had achieved a healthy weight by the end of treatment reported any kind of relapse. Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa. The one difference between the treatments was in patients from families with raised levels of maternal criticism. This group of patients had done less well at the end of treatment if they had been offered conjoint family meetings. At follow-up this difference was still evident, as shown in the relative lack of weight gain since the end of outpatient treatment. CONCLUSIONS: This study confirms the efficacy of family therapy for adolescent anorexia nervosa, showing that those who respond well to outpatient family intervention generally stay well. The study provides further support for avoiding the use of conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident.

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Physiol Behav. 2007 May 25; [Epub ahead of print]
Cause and treatment of anorexia nervosa.
Zandian M, Ioakimidis I, Bergh C, Södersten P.
Karolinska Institutet, Section of Applied Neuroendocrinology and Mandometer Clinic, AB Mando, S-141 01 Huddinge, Sweden.

The hypothesis that eating disorders are caused by an antecedent mental disorder, presently believed to be an obsessive compulsive disorder, has been clinically implemented during many years but has not improved treatment outcome. Alternatively, eating disorders are eating disorders and the symptoms of anorexic patients and probably bulimic patients as well, are epiphenomena which emerge as a consequence of starvation. This hypothesis is supported by the observations of the effects of a 6 month long period of semi-starvation on healthy human volunteers, which demonstrated not only the emergence of psychiatric symptoms but also the reduction in eating rate which is typical of anorexia nervosa patients. On this framework training anorexic patients how to eat may be a useful intervention. We report that anorexic patients, either with a body mass index <14 or >15.5 display the same pattern of eating behavior, with a low level of intake, a slow eating rate and a high level of satiety. They also have the same, high level of psychiatric symptoms, including obsessive compulsive symptoms. Training patients to eat more food at a progressively higher rate reverses these symptoms and patients remain free of symptoms during an extended period of follow-up. It is suggested that the pattern of eating behavior mediates between the starved condition and the psychopathology of anorexia nervosa.

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Compr Psychiatry. 2007 Mar-Apr;48(2):118-23. Epub 2006 Nov 7.
Body image in patients with eating disorders and their mothers, and the role of family functioning.
Benninghoven D, Tetsch N, Kunzendorf S, Jantschek G.
University of Schleswig-Holstein, Campus Luebeck, Clinic for Psychosomatic Medicine, 23538 Luebeck, Germany. benningh@medinf.mu-luebeck.de

OBJECTIVE: Little is known about body images of mothers of patients with eating disorders. In this study we investigated body image in patients with eating disorders and in their mothers, and the relationship of their body images with family functioning. METHODS: A computer program was used that allows modeling perceived and desired body images of patients and their mothers. Patients and mothers estimated their own body images and mothers estimated the images they have of their daughters with eating disorders. The selected images were compared to anthropometric data and family functioning according to the Family Assessment Measure. Data from 29 patients with the diagnosis of anorexia nervosa and 20 patients with bulimia nervosa are presented. RESULTS: Both in patients with anorexia and in patients with bulimia, aspects of family functioning were associated with mothers' and daughters' perceptual body size distortion and body dissatisfaction. Mothers' perception of family functioning predicted daughters' perceptual body size distortion and body dissatisfaction in the total sample of 49 patients. CONCLUSION: Body images of mothers and mothers' perceptions of family functioning may provide additional information for the treatment of patients with eating disorders.

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J Psychiatr Pract. 2007 Mar;13(2):65-71.
Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa.
Steinglass JE, Eisen JL, Attia E, Mayer L, Walsh BT.
New York State Psychiatric Institute and Columbia University Department of Psychiatry, New York, NY 10032, USA. js1124@columbia.edu

Anorexia nervosa (AN) is a serious mental illness, characterized in part by intense and irrational beliefs about shape and weight, including fear of gaining weight. Although these beliefs are considered to be a diagnostic criterion for the illness, they have not been systematically characterized. This study used the Brown Assessment of Beliefs Scale (BABS) to identify the dominant belief that interfered with eating in a sample of underweight patients with AN (N=25). The degree of insight was assessed quantitatively. The majority of participants (68%) spontaneously reported a dominant belief consistent with fear of gaining weight or becoming fat. Twenty percent of patients were categorized as delusional. The total score on the BABS was significantly correlated with the drive-for-thinness subscale of the Eating Disorders Inventory (EDI) (r=0.41, p=0.04), but did not correlate with overall measures of AN severity (body mass index [BMI], duration of illness, lowest BMI, other subscales of the EDI, or total EDI score). These findings highlight the centrality of fear of fat in AN and suggest the possibility that there is a subgroup of patients whose concerns about their weight reaches delusional proportions. This subpopulation of patients warrants further study, since patients with more delusional beliefs may have a form of AN that is more refractory to treatment.

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Psychoneuroendocrinology. 2007 Mar 27; [Epub ahead of print]
Olanzapine-induced weight gain in anorexia nervosa: Involvement of leptin and ghrelin secretion?
Brambilla F, Monteleone P, Maj M.
Department of Psychiatry, University of Naples SUN, Naples, Italy.

BACKGROUND: Olanzapine (OLA) administration has been reported to induce weight gain in experimental animals and humans, through not yet fully defined mechanisms of action. Aim of this study was to determine whether in patients with Anorexia Nervosa (AN) OLA induces weight gain through the modulation of the hunger-satiety regulatory peptides leptin and ghrelin. METHODS: Twenty anorexic probands received a 3 months course of cognitive-behavioral psychotherapy and programmed nutritional rehabilitation, combined with OLA PO (2.5mg for 1 month and 5mg for 2 months) in ten patients and with placebo PO (PL) in the other 10. Weight, measured as body mass index (BMI), leptin and ghrelin plasma values were monitored before starting the therapy and then monthly for 3 months. Plasma leptin was measured by ELISA, and plasma ghrelin by radioimmunoassay. RESULTS: BMI increased significantly but not differently in both treatment groups. Leptin and ghrelin secretion did not change during the course of the treatments. No correlations were observed between BMI values and leptin and ghrelin levels. CONCLUSIONS: Our data suggest that the weight gain observed in our OLA-treated patients was not linked to drug administration. Moreover, leptin and ghrelin secretions were not responsible for BMI changes.

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Eat Weight Disord. 2007 Mar;12(1):20-6.
Metabolic and psychological changes during refeeding in anorexia nervosa.
Konrad KK, Carels RA, Garner DM.
Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, USA. kkonrad@bgnet.bgsu.edu

OBJECTIVE: This study aimed to examine resting metabolic rate (RMR) and psychological changes during refeeding in 10 women with anorexia nervosa participating in a partial hospitalization eating disorder program. RESULTS: Participants' admission RMRs, as assessed by the MedGem Analyzer, were below their RMRs predicted by the Harris- Benedict equation, t(1,9)=5.77, p<0.01. Correlational analyses revealed a trend toward smaller increases in RMR being associated with higher admission BMI (r=-0.49, p=0.08), but not with highest lifetime BMI. Over the course of treatment, RMR per pound of Fat-Free Mass (FFM) increased from the beginning to the middle, t(1,9)=-3.02, p<0.05, and to the end stage of treatment, t(1,9)=-2.53, p<0.05. Scores on the Eating Attitudes Test-26, Eating Disorder Inventory-2, Brief Symptom Inventory (BSI), BSI Depression subscale, and Mizes Anorectic Cognitions scale significantly improved throughout treatment (all p<0.05); however, body dissatisfaction did not improve. DISCUSSION: Results suggest that weight restoration programs for anorexia nervosa cannot rely on FFM or standard formulas to predict caloric needs throughout refeeding, and that admission BMI is one factor to be considered in predicting caloric needs during refeeding. Furthermore, ways to improve body dissatisfaction during refeeding needs to be more of a treatment focus.

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Int J Eat Disord. 2007 Mar 16; [Epub ahead of print]
Anorexia nervosa treatment: A systematic review of randomized controlled trials.
Bulik CM, Berkman ND, Brownley KA, Sedway JA, Lohr KN.
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

OBJECTIVE:: The RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC) systematically reviewed evidence on efficacy of treatment for anorexia nervosa (AN), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics. METHOD:: We searched six major databases for studies on the treatment of AN from 1980 to September 2005, in all languages against a priori inclusion/exclusion criteria focusing on eating, psychiatric or psychological, or biomarker outcomes. RESULTS:: Thirty-two treatment studies involved only medications, only behavioral interventions, and medication plus behavioral interventions for adults or adolescents. The literature on medication treatments and behavioral treatments for adults with AN is sparse and inconclusive. Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration, although its efficacy in the underweight state remains unknown. Variants of family therapy are efficacious in adolescents, but not in adults. CONCLUSION:: Evidence for AN treatment is weak; evidence for treatment-related harms and factors associated with efficacy of treatment are weak; and evidence for differential outcome by sociodemographic factors is nonexistent. Attention to sample size and statistical power, standardization of outcome measures, retention of patients in clinical trials, and developmental differences in treatment appropriateness and outcome is required. (c) 2007 by Wiley Periodicals, Inc. Int J Eat Disord 2007.

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Psychother Psychosom Med Psychol. 2007 Mar 14; [Epub ahead of print]
[The Barbie-Matrix: Effectiveness of a School Based German Program for the Primary Prevention of Anorexia Nervosa Developed for Girls up to the Age of 12.]
[Article in German]
Berger U, Joseph A, Sowa M, Strauss B.
Institut fur Psychosoziale Medizin und Psychotherapie, Klinikum der Friedrich-Schiller-Universitat Jena.

More than 25 % of the 12-year-old girls in Thuringia (Germany) show problematic eating behaviour as measured with the Eating-Attitudes-Test (EAT-26D), which corresponds to an increased risk for the development of anorexia nervosa or bulimia nervosa. This was the starting position of a controlled study using a pre-post-design to check the effectiveness of a newly developed German program for the prevention of anorexia nervosa in girls ("PriMa"). 42 Thuringian schools (20 as treatment group) with 1006 girls participated in the pilot study, which lasted from September 2004 to July 2005. Program effectiveness was analysed with mostly standardized questionnaires at three times of measurement (before, after the intervention and at 3 months follow-up) referring to body related self esteem (FBeK), satisfaction with body shape (KEDS), eating behaviour (EAT-26D) and body related attitudes. The program was established in 9 x 90-minute lessons including interactive exercises and discussing especially developed posters that show scenes of a Barbie-doll's life including the reports of a patient suffering from anorexia. Significant improvements on all variables could be reached for the higher risk group (EAT-26D >/= 10 points; = 26,7 %). Mean values in the EAT-26D decreased 5 points at the average which is equivalent with 6.6 % of the EAT-26D range, reflecting a practically significant change effect.

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Prax Kinderpsychol Kinderpsychiatr. 2007;56(1):19-39.
[Intensive outpatient group treatment for adolescents with eating disorders]
[Article in German]
Michler P, Wolter-Flanz A, Linder M.
Klinik fur Kinder - und Jugendsychistrie Psychotherapie, Univeristatsstr, Regensburg. petra.michler@medbo.de

We present an intensive outpatient group treatment for girls with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder) additionally to/instead of inpatient treatment or individually treatment by psychotherapists. The therapy concept is primarily behaviour therapy oriented, encouraging the self-management-abilities of the patients thereby learning self-determination and responsibility in dealing with their illness. The slow-open group concept provokes group cohesion, solidarity and support among girls, who share similar age-related development-stages and eating disorders. Other than cognitive behaviour therapy and the principles of self-management we use client-centered therapy, art-, dance- and nutritional therapy. For each patient an individual treatment plan is adapted depending on age, individual symptoms, problems and motivation. Each member of the group has to accept defined group rules during the group sessions. The group takes place twice a week and on one Saturday per month. The adolescents stay in their social environment. Transfer of therapeutic success into daily life therefore is immediate and longlasting. Duration of therapy is between four months and one year, longer only in complex cases. Parallel to the parent/patient cooperation a parental psycho-educative group is available.

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Ann Pharmacother. 2007 Jan;41(1):111-5. Epub 2006 Dec 26.
The role of olanzapine in the treatment of anorexia nervosa.
Dunican KC, DelDotto D.
School of Pharmacy-Worcester, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA 01608, USA. Kaelen.Dunican@wor.mcphs.edu

OBJECTIVE: To evaluate the role of olanzapine in the treatment of anorexia nervosa. DATA SOURCES: Literature was obtained through searches of MEDLINE (1966-December 2006), EMBASE (1980-4th Quarter 2006), and PsycINFO (1985-December 2006) and a bibliographic review of published articles. Key terms used in the searches included anorexia nervosa, antipsychotics, eating disorders, olanzapine, and Zyprexa. STUDY SELECTION AND DATA EXTRACTION: All English language articles that were identified from the search were evaluated. All primary literature was included in the review. DATA SYNTHESIS: In several case reports and most clinical trials, patients with anorexia nervosa successfully gained weight while being treated with olanzapine. Moreover, many patients treated with olanzapine achieved a healthy body weight. Case reports and trials identified additional benefits of olanzapine, including reduction in delusional thinking; improvement in body image, sleep, depressive symptoms, adherence to treatment, and eating-disorder symptoms; and decreased agitation and premeal anxiety. CONCLUSIONS: Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5-15 mg daily promotes weight gain and has positive effects on associated psychological symptoms. Limitations of the reported data include small sample size, low completion rate in clinical trials, and open-label trial design. Although olanzapine appears to have a potential role in the treatment of anorexia nervosa that has been unresponsive to other therapy, randomized, placebo-controlled studies with larger sample sizes are necessary to establish its role in therapy.

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Int J Eat Disord. 2007 Jan;40(1):21-6.
Quetiapine in anorexia nervosa patients: an open label outpatient pilot study.
Powers PS, Bannon Y, Eubanks R, McCormick T.
Department of Psychiatry and Behavioral Medicine, College of Medicine, University of South Florida, Tampa, Florida, USA. ppowers@hsc.ucf.edu

OBJECTIVES: The main objective of the study was to determine whether quetiapine was effective in reducing scores on the positive and negative syndrome scale (PANSS) in anorexia nervosa (AN) patients. Secondary objectives included determining whether quetiapine was effective in reducing symptoms of anxiety and depression. In addition, the effect on weight was determined. METHOD: In an open label design, 19 patients with AN but without schizophrenia or schizoaffective disorder were given 150-300 mg quetiapine daily over a 10 week period. Results were analyzed using last observation carried forward (LOCF). RESULTS: Fourteen patients completed the study and all but one of the 5 patients who dropped out returned for an early termination visit. Scores on the total, general psychopathology, and depression scales of the PANSS declined significantly (p = .024, .010, .0005, respectively) at LOCF. There were improvements in several measures of anxiety, depression, and obsessive compulsive symptoms. Mean weight gain was modest at 1.6 lbs (0.73 kg). Adverse events were generally mild and no patients discontinued due to adverse events CONCLUSION: Quetiapine was well-tolerated and patients had significant improvements in several subscales of the PANSS as well as decreases in measures of anxiety and depression. (c) 2006 by Wiley Periodicals, Inc.

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J Am Diet Assoc. 2006 Dec;106(12):2073-82.
Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.
American Dietetic Association.

It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.

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Int J Eat Disord. 2006 Dec;39(8):625-32.
Specialist supportive clinical management for anorexia nervosa.
McIntosh VV, Jordan J, Luty SE, Carter FA, McKenzie JM, Bulik CM, Joyce PR.
Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand. virginia.mcintosh@chmeds.ac.nz

OBJECTIVE: This article presents the rationale for, and description of, a nonspecialized therapy for anorexia nervosa, called specialist supportive clinical management (SSCM). METHOD: Clinical management and supportive psychotherapy models of treatment are outlined. SSCM is described, as it was delivered in a clinical trial of psychotherapies for adult women with anorexia nervosa. RESULTS: The primary focus of SSCM for anorexia nervosa is the resumption of normal eating and the restoration of weight. Therapy aims to maintain a therapeutic relationship that facilitates the return to normal eating, and to enable other life issues that may impact on the eating disorder to be addressed. CONCLUSION: Possible effective components of SSCM are discussed. Copyright 2006 by Wiley Periodicals, Inc.

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J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1323-8.
Is family therapy useful for treating children with anorexia nervosa? Results of a case series.
Lock J, le Grange D, Forsberg S, Hewell K.
Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, CA 94305, USA. jimlock@stanford.edu

OBJECTIVE: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. METHOD: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting diagnostic criteria for AN (n=29) and eating disorder not otherwise specified-restricting type (n=3) who were treated at two sites with FBT. Baseline characteristics, before and after weights, and Eating Disorder Examination (EDE) scores were compared with an adolescent cohort (N=78) with a mean age of 15.5 years (range 13.1-18.4) who were treated with FBT. RESULTS: Children with AN share most disordered eating behaviors with their adolescent counterparts; however, their EDE scores are significantly lower than adolescents at both pre- and posttreatment assessments. Over the course of treatment with FBT, children showed statistically and clinically significant weight gain and improvements in eating disordered thinking as measured by the EDE. CONCLUSION: FBT appears to be an acceptable and effective treatment for AN in children.

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J Marital Fam Ther. 2006 Oct;32(4):505-14.
Juvenile anorexia nervosa: family therapy's natural niche.
Fishman HC.
New Zealand Eating Disorder Specialists, New Zealand. charles@fishman.co.nz

Juvenile Anorexia Nervosa (AN) is a severe problem both in terms of presenting symptomatology and its tendency toward chronicity. Researchers have consistently shown that family-based approaches are superior to individual approaches for the treatment of juvenile AN. This article addresses the capacity deficit of trained family therapists to treat this disease. The author reviews the effectiveness of Structural Family Therapy as a treatment of juvenile AN and the essential concepts and skills required by the family therapist to treat this disorder. The concepts of therapeutic crisis induction, enactment, and therapeutic intensity are discussed in detail. Recommendations are made for future research.
   

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