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Neuro > Eating disorders 2 > Flashcards

Eating disorders 2 Flashcards

1
Q

Matching interventions

A

Therapies focus on different elements in the aetiology and maintenance of eating disorders (biology, genes, trauma, bullying)

The most effective interventions focus on maintenance factors (safety behaviours, cognitive patterns, emotional patterns)

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2
Q

Prevention of eating disorders

A

Potential targets :

  • A lowering of eating and other concerns in present
  • A lower level of future development of ED

Not always risk free
Carter et al (1997) and Baronowski & Heatherington (2001) tried psychoeducation about dieting and EDs on kids (11-14)
The level of pathology got worse
Wasn’t a success

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3
Q

Which preventions works?

A

Media literacy approaches reduce shape and weight concerns in males and females in young population

Cognitive dissonance approaches reduce eating behaviours and attitudes in high risk groups

CBT intervention reduce risk

Weight management interventions reduce some risk factors

Some evidence that fewer people are developing EDs

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4
Q

Complexity of obesity

A

Nice (2015) recommends interventions involving schools, gov, families rather than specific psychological interventions

Encouraging lifestyle changes healthy eating (routine exercise)

Obesity rates :

  • almost 3/4 of people aged 45-74 are overweight or obese
  • risen from 14.9% to 28% since 1993
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5
Q

Effective treatments for anorexia nervosa

A

Adults

Individual CBT for EDs (40 sessions)
* Maudsley anorexia nervosa treatment for adults (20-30 sessions)
* specialist supportive clinical management (20-30 sessions)
* similar level of effectiveness to behaviour therapy *(Waller & Raykos, 2019)

Children and adolescents

  • AN focused family therapy (non-blaming > family starts by taking control of the child’s eating > move to giving child control back > finished with relapse prevention)
  • CBT-ED works well as an alternative (Craig et al, 2019)
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6
Q

Effective treatments for BN and BED

A

Adults or adolescents with BED

*Group or individual CBT-ED (16-20 sessions)

Adults with BN

  • Individual CBT-ED (16-20 sessions)

Children and adolescents with BN

  • Family therapy
  • CBT-ED
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7
Q

Effective treatments for other disorders

A

Atypical cases

  • Use the therapy recommended for the most similar full syndrome
  • Atypical BN use CBT-ED

Avoidant and restrictive food intake disorder

  • Not addressed by NICE (2017) so too early to have evidence base
  • Some evidence of CBT-AR (Thomas & Eddy, 2018)
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8
Q

Common elements for what works

A

Key element of treatment = starting with food/exposure to foods (there are physical, cognitive benefits)

It is not clear whether therapies do more in underweight cases

There is extra value in the psychological element of therapy in non-underweight cases

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9
Q

What else is effective?

A

NICE covers the most strongly supported studies so they should be used as a priority

However, some other approaches do have evidence to support them but they do not meet the NICE criteria of enough quality research and not as effective as what the guidelines recommend

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10
Q

Need for risk management

A

Medical monitoring and management

Intensive treatments

  • Uses vary in cultures - Germany :) > UK :(
  • Can be good for weight restoration
  • Almost no evidence for establishing recovery
  • Very expensive
  • Could create dependence
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11
Q

How effective are the best therapies?

A

Hansen et al (2002) - Mean effectiveness

  • 50% recovery
  • 25% improvement
  • 20% unchanged
  • 5% deteriorate
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12
Q

Importance of biology

A

Addressing eating and nutrition has a wide range of effects

  • Reduces anxiety, depression, impulsivity and compulsivity
  • Reduces alcohol levels
  • Enhances cognitive flexibility and social skills
  • Normalises and stabilises weight
  • Enhances quality of life
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13
Q

Obesity

A

Not a matter of choice

Genetics, learning, SL > hunger
Social pressure, toxic environment > Satiety

We have to work with psychology and biology

Therapies = poor outcomes Jeffrey et al (2000)
Good at getting people to lose weight in short term but terrible in long term

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14
Q

What can we do about obesity

A
  • Do not blame and abandon
  • Political and social changes (sugar tax, risk of fat shaming)
  • Lifestyle coaching (food choices and exercise)
  • Longer therapy (limited benefits)
  • Continuing care model seems to work (Latner et al, 2000)
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15
Q

Treatment for obesity : Gastro…

A

Most effective long term route to weight loss is bariatric surgery

Problems :

  • Mostly adaptation to lifestyle changes
  • Psychological preparation
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