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neuroclin 1 > eating disorders - treatments > Flashcards

eating disorders - treatments Flashcards

1
Q

issues with treatments used for ED
- 5 key issues identified

A

Lilienfeld et al (2013)

concerns with treatments of EDs
600 therapies identified
few actually evidence-based and some were strange
most clinicians didn’t deliver evidence-based treatments:
* only 38% used strongest therapy
* take out key elements of therapies
* 6% used evidence-based treatment manuals
* many do “eclectic” or “integrative” therapies
* many untrained in therapy

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2
Q

causes and maintenance of eating disorders (7)

A
  • biology
  • genes
  • family interaction
  • sociocultural influences
  • trauma
  • bullying and teasing
  • negative life experiences
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3
Q

maintenance factors of EDs (6) - interventions based on these

A
  • safety behaviours
  • cognitive behaviours
  • emotional patterns
  • social maintenance
  • family accommodation of symptoms
  • nutrition (neurobiology link)
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4
Q

are ED treatments evidence based

A

often not
backed up by clinical practice rather than actual evidence

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5
Q

prevention of eating disorders - potential targets for interventions (2)

A

reducing eating concerns in the present
reducing future development of EDs

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6
Q

prevention of EDs - who, what approach, why

A

implement in late childhood/early adulthood
protect against development of EDs
limited investment -> e.g. implement into school curriculum so it is wide reaching
better to prevent than to treat it

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7
Q

risk of preventions of EDs - 2 studies

A

Carter et al (1997) & Baronowski & Heatherington (2001)

both tried psychoeducation about dieting and EDs
targeted school kids age 11-14

levels of pathology got worse - short and long term

Carter said it was a problem → but Baronowski said it was a success (it wasn’t → reporting issues)

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8
Q

which prevention strategies of EDs work (4)

A

Le et al (2017)
review and meta-analysis of 58 studies found:

media literacy approach:
* reduce shape and weight concerns for males and females in young population

cognitive dissonances approaches:
* reduces eating behaviours and attitudes in high-risk groups

CBT interventions:
* reduce risk of dieting

weight management interventions
* reduce some risk factors

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9
Q

is there evidence for preventative measures of EDs

A

there is evidence for reduction in risk factors/current pathology

limited evidence for prevention → unclear whether fewer people develop eating disorders

need to get better at reducing those numbers of cases - to justify effort on prevention work

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10
Q

obesity - NICE recommendations for reduction

A

NICE = schools, local gov, families, tax policies → rather than psychological interventions

encouraging lifestyle changes → healthy eating, regular exercise

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11
Q

obesity rates in England

A

almost 3/4 of people age 45-74 are overweight or obese

1998 = 14.9% obese
2021 = 28% obese

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12
Q

NICE guidelines for who gets what ED treatment – 2 parameters

A

adults and children/adolescents

underweight vs non-underweight patients

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13
Q

NICE adult treatments of anorexia (3)

A

CBT-ED (individual CBT for eating disorders) → 40 sessions

MANTRA → Maudsley Anorexia Nervosa Treatment for Adults → 20-30 sessions

SSCM → Specialist Supportive Clinical Management → 20-30 session

these are similarly effective to behaviour therapy

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14
Q

NICE child/adolescent treatment of anorexia (2)

A

AN-focused family therapy:
* non-blaming
* family takes control of child’s eating
* then move to give control back to child
* finish with relapse prevention

CBT-ED or adolescent-focused psychotherapy as a second option

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15
Q

NICE adult treatment of BED and BN

A

binge eating disorder:
group CBT-ED or individual CBT-ED → 16-20 sessions

bulimia nervosa:
individual CBT-ED or try self-help CBT-ED first → 16-20 sessions

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16
Q

NICE child/adolescent treatment of BN (2)

A

family therapy for bulimia nervosa
CBT-ED as a second line therapy

17
Q

NICE treatment of OSFED

A

atypical cases so use the therapy recommended for most similar full syndrome

18
Q

NICE treatment of ARFID

A

avoidant and restrictive food intake disorder

not in NICE (2017) - new so limited evidence base

some early evidence for CBT-AR as treatment

19
Q

why are certain treatments of ED are included in NICE

A

NICE covers most strongly evidence based therapies

so prioritise these with limited resources

drives commissioning advice for NHS

addresses issues around case management and patient experience

20
Q

why aren’t some therapies in NICE guidelines

A

don’t meet NICE guidelines for high-quality research
or not found to be effective enough

weak research or unsupported clinician opinion

21
Q

why is case/risk management important

A

medical monitoring and management to address risks and allocate resources effectively

with intensive treatments (inpatients and day-patients)

22
Q

does length of treatment impact its effectiveness

A

shorter therapies can be just as effective for non-underweight EDs

23
Q

therapeutic alliance with ED - is it important?

A

more complex than just therapist getting on well with the patient
also need to get them to agree to the therapy

good alliance doesn’t necessarily predict good outcomes

24
Q

is early treatment necessary

A

early change was important with predicting positive outcomes of treatment

25
Q

does severity or duration of ED reduce effectiveness of treatments

A

no evidence for this -> shouldn’t be defeatist

26
Q

intensive treatments of EDs (6) - eval

A

inpatient and day-patients:

  • varies culturally (common in Germany, rare in UK)
  • necessary for management of high-risk cases
  • good for weight restoration
  • almost no evidence for establishing recovery
  • very expensive
  • risk of creating dependence
27
Q

medications for ED (2) - weaker old evidence

A

SSRIs at high doses for BN:
* enhances functional serotonin
* reduces binges for some people whilst taking it - not longer term
* potential withdrawal → SSR discontinuation syndrome

novel antipsychotics for AN:
* olanzapine, quetiapine, risperidone
* reduces anxiety, enhance weight gain through metabolic slowing

28
Q

physical interventions for ED (2) - old/weaker evidence

A

neuromodulation:
* transcranial stimulation → reduce depression slightly - no evidence that this works yet

leucotomy:
* for chronic AN with extreme OCD
* evidence is anecdotal and poor

29
Q

psychological therapies for ED - with some evidence (4)

A

DBT - dialectical behaviour therapy:
* reduce impulsive behaviours in BED/BN - limited change in core pathology
* limited evidence for AN

IPT - interpersonal psychotherapy:
* works for BN, lower and less effective than CBT

FIT - focused psychodynamic approaches:
* effective for AN, needs replication in other countries

integrative cognitive-affective therapy:
* less effective than CBT

30
Q

psychological therapies for ED - with little evidence (4)

A

mentalisation-based therapu

acceptance and commitment therapy

mindfulness-based approaches

family therapies that aren’t food/eating focused

31
Q

effectiveness of best ED therapies (%)

A

mean effectiveness of evidence based therapies for adult psychological disorders

50% recover
25% improve
20% unchanged
5% deteriorate

32
Q

recovery rate in underweight and non-underweight cases

A

can get a 50% recovery rate → only in non-underweight cases

30% in underweight cases

33
Q

CBT-ED and family therapies - ED with psychobiology

A

both therapy types target different core beliefs of EDs

help them restore homeostasis regarding eating behaviour

teach to eat in response to biological needs - keep energy graphs stable so you don’t purge or binge

not with toxic environment or inner psychological concerns

34
Q

why address biology of EDs - positive impacts (5)

A

reduces anxiety, depression, impulsivity, compulsivity → serotonin levels

reduce alcohol levels → mood stability and starvation reduction

enhance cognitive flexibility → reduce starvation effects and safety behaviours

normalises and stabilises weight

enhance quality of life → result of all of the above

35
Q

multifaceted reasons for obesity

A

genetics, learning, social learning, social pressures, food industry and toxic environment → all in this context

not due to choice

36
Q

do psychological therapies have good outcomes for obesity

A

good at short-term weight loss
bad at keeping weight off long-term

Cooper et al (2010):
new CBT for obesity - but it didn’t work well

even 5-10% weight loss can have health benefits:
* struggle to achieve this → biology and toxic environment combined

37
Q

what to do about obesity (5)

A

don’t blame individual → big quality of life change possible

politics → sugar tax, risk of fat shaming

lifestyle coaching → advice about food choices, but this doesn’t last when coaching stops

longer term therapy → still issue when therapy ends it doesn’t last

continuing care model → most likely to work

38
Q

non-psychological treatments of obesity

A

bariatric surgery:
* gastric bypass
* sleeve gastrectomy
* gastric band

each has its own issues → adaptation to lifestyle changes and making slow progress

requires psychological preparation and maintenance strategies:
* psychological involvement with this to combine with the surgery

neuroclin 1 (9 decks)

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