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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt, Ulrike, Sharpe, Helen, Bartholdy, Savani, Bonin, Eva-Maria, Davies, Helen, Easter, Abigail, Goddard, Elizabeth, Hibbs, Rebecca, House, Jennifer, Keyes, Alexandra, Knightsmith, Pooky, Koskina, Antonia, Magill, Nicholas, McClelland, Jessica, Micali, Nadia, Raenker, Simone, Renwick, Bethany, Rhind, Charlotte, Simic, Mima, Sternheim, Lot, Woerwag-Mehta, Sabine, Beecham, Jennifer, Campbell, Iain, Eisler, Ivan, Landau, Sabine, Ringwood, Susan, Startup, Helen, Tchanturia, Kate and Treasure, Janet (2017) Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice. Programme Grants for Applied Research, 5 (16). ISSN 2050-4322

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Identification Number: 10.3310/pgfar05160

Abstract

Background Anorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited. Objectives This programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness. Methods WP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England. Results WP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011. Conclusions This programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change. Trial registration Current Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.

Item Type: Article
Official URL: https://www.journalslibrary.nihr.ac.uk/pgfar/#/
Additional Information: © 2017 Queen’s Printer and Controller of HMSO
Divisions: Health Policy
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Sets: Departments > Health Policy
Date Deposited: 05 Jul 2018 11:52
Last Modified: 24 Sep 2019 23:07
Funders: National Institute for Health Research
URI: http://eprints.lse.ac.uk/id/eprint/89067

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