Anorexia nervosa (AN) is a serious mental disorder, characterized by severely low weight and cogn... more Anorexia nervosa (AN) is a serious mental disorder, characterized by severely low weight and cognitive distortions about body shape and weight. AN is generally associated with a constellation of psychological symptoms, including depression, anxiety, obsessionality, and ritualistic behaviors. The presence of these associated symptoms, together with the great challenge of treating patients with AN, has led clinicians to try many psychopharmacologic agents in the treatment of these patients, usually to no avail. Investigators have studied a range of agents, but have found little, if any, utility in treating underweight patients with medication. In this article, the authors review the literature regarding medication treatment for patients with AN, propose a theoretical basis for the poor response of these patients to the agents that have been tried, and conclude with recommendations for treatment strategies and additional research that should be pursued to further our understanding of this difficult illness.
Across studies, adolescents score lower on measures of eating disorder pathology than adults, but... more Across studies, adolescents score lower on measures of eating disorder pathology than adults, but it is unclear whether such findings reflect discrepancies inherent to site/study or true developmental differences. The aim of this study was to determine whether age predicts subscale and diagnostic scores of the Eating Disorder Examination (EDE) in adolescents and adults with anorexia nervosa (AN) admitted to a single research center within the same period of time. The sample consisted of 16 adolescent and 20 adult consecutive admissions to parallel, age-specific, research-based AN treatment programs. Participants completed a baseline evaluation at admission that included the EDE, depression measures, and global assessment of functioning scales. Age significantly predicted EDE scores in univariate regression analyses. However, in multivariate models that included severity indices of general and specific psychopathology as covariates, age was no longer a significant predictor of severity of eating disorder symptoms. This study adds to the growing body of data showing lower scores on the EDE for adolescents with AN relative to their adult counterparts, while eliminating potential site confounds. Results indicate that the higher adult scores may be carried in part by a more overall severe and chronic general clinical profile.
Objective-Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospi... more Objective-Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating-related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and OCD, namely exposure therapy and response prevention.
Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have... more Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have reported few differences between patients who meet the full DSM-IV criteria for AN and those who meet all but the amenorrhea criterion. Although this suggests that the absence of menses does not provide critical diagnostic information, many of these studies are limited by small sample sizes. This study aims to examine the clinical utility of amenorrhea as a criterion for the diagnosis of AN. A chart review was conducted of 240 consecutive patients admitted for inpatient treatment at the NY State Psychiatric Institute from 1993 to 2006. Menstrual data were collected from the Eating Disorder Examination conducted upon admission. Independent samples t-tests were performed to evaluate differences in clinical variables, including age, lifetime lowest body mass index (BMI), admission and discharge BMI, previous number of hospitalizations, duration of illness, Beck Depression Inventory total score, Beck Anxiety Inventory total score, and Eating Disorder Examination subscale scores. The amenorrheic and menstruating groups differed significantly only on lowest lifetime BMI and admission BMI, with individuals with amenorrhea having lower BMIs on both measures. These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information. Future studies are needed to examine the potential prognostic value of menstrual status.
Objective: This study examined the frequency and characteristics of alli 1 use among patients in ... more Objective: This study examined the frequency and characteristics of alli 1 use among patients in eating disorder treatment facilities.
The International journal of eating disorders, 2007
Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and ... more Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and also reduces 'binge-like' eating in rodents. We hypothesized that baclofen might be effective in reducing binge eating episodes in binge eating disorder (BED) and bulimia nervosa (BN). Seven women with BED (n = 4) or BN (n = 3) took baclofen (60 mg/day) for 10 weeks. Six out of seven patients completed the full 10-week trial. Five out of seven participants (3 BED; 2 BN) demonstrated 50% or greater reduction of frequency of binge eating from beginning to end of the study. Three out of seven participants (2 BED; 1 BN) were free of binge eating at study end. Four out of seven participants elected to continue baclofen at study end. Baclofen was well tolerated by the participants. In this open-label trial, baclofen was associated with decreased binge eating frequency in patients with BED and BN.
Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain ... more Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients. Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined. The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York. This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.
... Behavioral Management for Anorexia Nervosa. Evelyn Attia, MD, and B. Timothy Walsh, MD. ... 2... more ... Behavioral Management for Anorexia Nervosa. Evelyn Attia, MD, and B. Timothy Walsh, MD. ... 22. Eisler I , Simic M , Russell GF , Dare C . A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. ...
more delusional beliefs may have a form of AN that is more refractory to treatment. (Journal of P... more more delusional beliefs may have a form of AN that is more refractory to treatment. (Journal of Psychiatric Practice 2007;13:65-71)
Background:Anorexianervosa(AN)isaseriouspsychiatricillness associated with significant morbidity ... more Background:Anorexianervosa(AN)isaseriouspsychiatricillness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, andtherateofrelapseisestimatedtobeashighas50%.Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients. Objective:Theobjectiveofthestudywastodeterminewhetherdiet energy density and diet variety in recently weight-restored women with AN predict outcome. Design:After gaining weight to
Anorexia nervosa (AN) is a serious mental disorder, characterized by severely low weight and cogn... more Anorexia nervosa (AN) is a serious mental disorder, characterized by severely low weight and cognitive distortions about body shape and weight. AN is generally associated with a constellation of psychological symptoms, including depression, anxiety, obsessionality, and ritualistic behaviors. The presence of these associated symptoms, together with the great challenge of treating patients with AN, has led clinicians to try many psychopharmacologic agents in the treatment of these patients, usually to no avail. Investigators have studied a range of agents, but have found little, if any, utility in treating underweight patients with medication. In this article, the authors review the literature regarding medication treatment for patients with AN, propose a theoretical basis for the poor response of these patients to the agents that have been tried, and conclude with recommendations for treatment strategies and additional research that should be pursued to further our understanding of this difficult illness.
Across studies, adolescents score lower on measures of eating disorder pathology than adults, but... more Across studies, adolescents score lower on measures of eating disorder pathology than adults, but it is unclear whether such findings reflect discrepancies inherent to site/study or true developmental differences. The aim of this study was to determine whether age predicts subscale and diagnostic scores of the Eating Disorder Examination (EDE) in adolescents and adults with anorexia nervosa (AN) admitted to a single research center within the same period of time. The sample consisted of 16 adolescent and 20 adult consecutive admissions to parallel, age-specific, research-based AN treatment programs. Participants completed a baseline evaluation at admission that included the EDE, depression measures, and global assessment of functioning scales. Age significantly predicted EDE scores in univariate regression analyses. However, in multivariate models that included severity indices of general and specific psychopathology as covariates, age was no longer a significant predictor of severity of eating disorder symptoms. This study adds to the growing body of data showing lower scores on the EDE for adolescents with AN relative to their adult counterparts, while eliminating potential site confounds. Results indicate that the higher adult scores may be carried in part by a more overall severe and chronic general clinical profile.
Objective-Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospi... more Objective-Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating-related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and OCD, namely exposure therapy and response prevention.
Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have... more Amenorrhea is a DSM-IV criterion for the diagnosis of anorexia nervosa (AN). Several studies have reported few differences between patients who meet the full DSM-IV criteria for AN and those who meet all but the amenorrhea criterion. Although this suggests that the absence of menses does not provide critical diagnostic information, many of these studies are limited by small sample sizes. This study aims to examine the clinical utility of amenorrhea as a criterion for the diagnosis of AN. A chart review was conducted of 240 consecutive patients admitted for inpatient treatment at the NY State Psychiatric Institute from 1993 to 2006. Menstrual data were collected from the Eating Disorder Examination conducted upon admission. Independent samples t-tests were performed to evaluate differences in clinical variables, including age, lifetime lowest body mass index (BMI), admission and discharge BMI, previous number of hospitalizations, duration of illness, Beck Depression Inventory total score, Beck Anxiety Inventory total score, and Eating Disorder Examination subscale scores. The amenorrheic and menstruating groups differed significantly only on lowest lifetime BMI and admission BMI, with individuals with amenorrhea having lower BMIs on both measures. These results indicate that amenorrhea does not distinguish between groups on a number of important measures of clinical severity. It may be that amenorrhea reflects weight and nutritional status, rather than providing useful diagnostic information. Future studies are needed to examine the potential prognostic value of menstrual status.
Objective: This study examined the frequency and characteristics of alli 1 use among patients in ... more Objective: This study examined the frequency and characteristics of alli 1 use among patients in eating disorder treatment facilities.
The International journal of eating disorders, 2007
Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and ... more Baclofen is a GABA-B agonist that may be useful in the treatment of substance use disorders, and also reduces 'binge-like' eating in rodents. We hypothesized that baclofen might be effective in reducing binge eating episodes in binge eating disorder (BED) and bulimia nervosa (BN). Seven women with BED (n = 4) or BN (n = 3) took baclofen (60 mg/day) for 10 weeks. Six out of seven patients completed the full 10-week trial. Five out of seven participants (3 BED; 2 BN) demonstrated 50% or greater reduction of frequency of binge eating from beginning to end of the study. Three out of seven participants (2 BED; 1 BN) were free of binge eating at study end. Four out of seven participants elected to continue baclofen at study end. Baclofen was well tolerated by the participants. In this open-label trial, baclofen was associated with decreased binge eating frequency in patients with BED and BN.
Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain ... more Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients. Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined. The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York. This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.
... Behavioral Management for Anorexia Nervosa. Evelyn Attia, MD, and B. Timothy Walsh, MD. ... 2... more ... Behavioral Management for Anorexia Nervosa. Evelyn Attia, MD, and B. Timothy Walsh, MD. ... 22. Eisler I , Simic M , Russell GF , Dare C . A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. ...
more delusional beliefs may have a form of AN that is more refractory to treatment. (Journal of P... more more delusional beliefs may have a form of AN that is more refractory to treatment. (Journal of Psychiatric Practice 2007;13:65-71)
Background:Anorexianervosa(AN)isaseriouspsychiatricillness associated with significant morbidity ... more Background:Anorexianervosa(AN)isaseriouspsychiatricillness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, andtherateofrelapseisestimatedtobeashighas50%.Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients. Objective:Theobjectiveofthestudywastodeterminewhetherdiet energy density and diet variety in recently weight-restored women with AN predict outcome. Design:After gaining weight to
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