Eating disorders, Treasure et al. (2020)

Question 1

wat heeft dit onderzoek laten zien over de behandeling van AN

Answer 1

Meta-analysis across the age spectrum has not found a difference between psychological treatment and comparison interventions on weight gain, eating disorder psychopathology, or quality of life. Also, meta-analysis concluded that there is insufficient evidence to guide the choice of treatment setting.

Question 2

first-line treatment =

Answer 2

family-based interventioons, recommended by treatment guidelines (but evidence for this not very solid)

Question 3

nutritional treatment =

Answer 3

inpatient treatment which involves meal support, sometimes through enteral feeding (with a tube: nasogastric feeding through the nose)

may lead to increase in weight gain and/or decrease in binging, with few adverse effects.

Question 4

inpatient treatment=

Answer 4

next to meal support, also psychosocial, educational and pharmacological interventions.

Question 5

evidence voor effectivity hospitalization en waarmee gecombineerd?

Answer 5

• Short hospitalization (for medical stabilization) followed by family-based or day-treatment has similar outcomes to longer hospitalization (until weight restoration).
• Outpatient family therapy after hospitalization seems superior to treatment as usual alone.
• Therefore: A combination of short-hospitalization (including meal support) and family-based interventions might be optimal for adolescents with AN.

Question 6

first line treatments for adults with AN

Answer 6

several structured individual therapies, including:
- CBT,
- Maudsley Model of AN,
- focal psychodynamic psychotherapy,
- Specialist Supportive Clinical Management.

(Studies show little or no differences in efficacy between them: all of them lead to improvements in body weight and reductions in symptoms, distress levels, and clinical impairment.)

Question 7

inpatient treatment adults AN: prevalence and efficacy

Answer 7

about 20-40% of adults requires higher intensity care (day- or inpatient treatment) because of high risk or irresponsiveness to outpatient treatment.

Inpatient treatment is effective at improving nutritional health but a proportion of patients relapses. Thus, additions of digital interventions and carer support might be added.

Question 8

pharmacotherapy for AN

Answer 8

olanzapine has a small positive effect on weight gain and agitation. however, no change in psychopathology was observed

Question 9

bulimia nervosa treatment adolescents

Answer 9

• family-based therapy
• CBT given in the form of guided self care (can be shared with parents)

Question 10

bulimia nervosa treatment in adults

Answer 10

• guided self-help
• therapist-delivered CBT

(however, over 60% of the patients fail to fully abstain from core symptoms even after these treatments)

Question 11

therapy for binge-eating disorder

Answer 11

• CBT
• guided self help (less expensive, but also less effective)
• third wave therapies (mindfulness, acceptance and commitment therapy) not superior to CBT

Question 12

bulimia nervosa pharmacotherapy

Answer 12

fluoxetine treatment had minor efficacy in promoting remission compared to other treatments.

Question 13

binge eating disorder pharmacotherapy

Answer 13

Binge-eating disorder: pharmacotherapy produced greater levels of weight loss, equivalent reduction in binges, but lower reduction in psychopathology compared to placebo treatment.

Question 14

wat is het beleid bij milde/gematigde patients

Answer 14

the first step is outpatient psychological treatment, might involve family members. if medical or psychological risk is high or there is irresponsiveness to outpatient care, greater intensity of care can be provided in the form of day- or inpatient-treatment.