PSY2003 W6 Eating Disorders 2 - (L) Flashcards
How many clinicians report using the strongest therapy for eating disorder?
38% Report using strongest therapy, but they may take out key elements
How many clinicians report using evidenece-based treatment manuals?
Only 6% report using evidence based tretment manuals.
What do other therapies do clinicians deliver?
more deliver unevidenced ‘eclectic’ or ‘integrative’ therapies and many are untrained in the therapy they are using
What are some concerns about treatment of eating disorder that were identified by Scott Lilienfeld et al. 2013?
Over 600 therapies were identified in total, quite a few could be seen as wacky, many described as evidence-based, very few were evidence based
Matching intervention to the pathology: what makes different therapies different?
Different therapies have focused on different elements in the aetiology and maintenance of eating disorder.
What are some focus points of different therapies?
Biology, Genes, Family interaction, Sociocultural influences, trauma, bullying and teasing, negative life expereinces and many more
The most effective interventions focus on what factors?
Maintenance factors
What are some types of maintenance factors?
Safety behaviours, cognitive patterns, emotional patterns, social maintenance, family accommodation of symptoms, nutrition ( neurobiology)
What is an obvious approach in treating eating disorder?
Prevention methods
When would it be ideal to implement prevention methods?
Late childhood/early adolescence
Why is this method a good idea? - link to gov/economy
Massive potential benefits for limited investment
What are potential targets?
Lowering of eating and other cnocerns in the rpesent. Lower level of future development of eating disorders
Is prevention always good?
No it is not always risk- free, exampel with carter et al 1997 and Baronowski and Heatherington’s prevention interventions
Briefly explain Carter 2001 and Baronowski’s preventions
Both tried psychoeducation about dieting and eating disorder, targeted on schoolchildren aged 11-14.
What was the results of carter et al. 1997 and Baronowski & Heatherington 2001 prevention intervention?
Both cases the level of pathology got worse, Baronowski - short term, Carter - long term
What was problematic of the conclusions of these cases?
Carter did report this as a problem but others reproted it as success
What are some prevention approaches that work?
Le et al. (2017 - Clinical Psychology Review), Media Literacy approaches, Cognitive dissonance appraoches, CBT and weight manageemnt interventions
What was Le et al 2017 review ?
Carried out a review and meta-analysis, based on 58 studies, a lot fo the studies were weak, limiting the conclusions
What is the effect of a media literacy approache?
It reduces shape and weight concersn for everyone in the whole young population
What is the effect of Cognitive dissonance approaches?
Reduce eating behaviours and attitudes in high-risk groups
What is the CBT affect?
Reduce risk of dieting
What affect does weight management have?
Reduce some risk factors
What evidence for reduction in risk factors/current pathology?
Dissonance based approaches Stice et al, 2013
What do the authors of prevention approaches stres?
That we need to get better at reducing those numbers of cases, jusitifying the effort spent on prevention work
Why are recommendations for obesity so diverse?
Because obesity is complex
What does NICE (2015) recommed for obesity?
recommends interventions involving schools, local government, families, policies such as taxation, etc.
What are some other recommedation for obesity?
Encouraging lifestyle changes healthy eating - routine exercise,
What is a state of obesity in england?
Since 1993, the proportion of individuals who are obese has risen from 14.9% to 28% (Health Survey for England, 2021)
What is the strongest evidence ?
Is what is reflected in the NICE guideline (2017) - Davey used the 2004 guideline so should be considered out of datte regarding the evidence
Do NICE guidelines match most toehr guidelines internatinoally?
Yes
What are some primary differences in NICE guidelines?
Between adults vs children/adolescents and underweight vs non-underweigth pateints
What are some effective tretments for anorexia nervosa in adults?
Individual CBT, MANTRA, SSCM and behvaiour therapy
How many session for Individual CBT for eating disorder (CBT-ED) - adults
40 Sessions
How many session for Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
20-30 sessions
How many session for Specialist supportive clinical management (SSCM)
20-30 sessions
What are some Similar level of effectiveness to behaviour therapy
Waller and Raykos
What are some effective tretment for anorexia nervosa for children and adolescents
AN-focused family therapy and CBT-ED or Adolescent focused psychotherapy as a second option
What is AN-focused family therapy ?
Non-blaming, stop accommodating patterns, family starts by taking contorl of the child’s eating, then moves to giving that control back to the child, finishes with relapse prevention
When is CBT-ED useful?
CBT-ED or Adolescent-focused psychotherapy as a second option CBT-ED works well as an alternative (Craig et al., 2019)
What are some effective tretments for adults or adolescents with BED?
Group or individual CBT-ED (16-20 sessions),
What are some effective treatments for adults with BN?
Inidvidual CBT-ED (Can try guided self-help CBT-ED first (16-20 session)
What are some effective treatments for achildren and adolescents with BN
Family therapy for BN, CBT-ED as a second lin etherapy
What are some effective treatments for other disorder - atypical cases (OSFED)
Use the therapy recommended for the most similar full syndrome
What are some effective treatments for avoidatn and restrictive food intake disroder (ARFID)
Not addressed by NICE 2017 (to new to have an evidence base), Some early evidence for CBT-AR (Thomas and Eddy 2018)
Longer duration therapies will always be more effective?
False
Therapeutic alliance is always the most important factor to alliance in determining treatment outcomes?
False
Early change I scritical to treatment outcomes?
True, Vall and Wade 2015 (meta-analyses)
Severity and long duration of eating disorder reduces effectiveness of treatment
False, Raykos et al 2018
What are some common elements of what works?
food as the key element of treatment, single most important element is nutrition/exposure to foods (physical, cognitive, emotional and sociol benefits)
What are the difference between underweight cases and unon underweight cases when looking at common elements of what works?
Underweight cases - not clear whether the rest of these therapies does much more (Waller & Raykos, 2019) and Non-underweight cases - extra value in the psychological element of therapy
Who covers the therapies that are most strongly suppoted by the evidence?
Nice, which is why it should be used as a priority and in a resource limiting setting (everywhere), drives commissioning advice for NHS, addresses isseus around case management and patient expeirence
What about other approaches not mentioned by NICE?
Not meeting the NICE criteria of enough high quality research. Not as effective as what the guidelines recommend. Still not including very weak research (e.g. dolphin therapy) or unsupported clinician opinion
What are some ase/risk management that are needed?
Medical monitoring and management (addressing the risks covered last time), intensive tretments
What are intensive treatments (in and day patients)
Use varies across cultures (e.g., almost universal in Germany, rare in UK). Necessary for management of high-risk cases. Can be good for weight restoration
What are some limitation of intensive treatments
Almost no evidence of establishing recovery. Very expensive. Risk of creating dependence
Some weaker aproaches could have been what - NICE?
Therapies that have been recommended in the past (NICE, 2004) but have not been retained (NICE, 2017) because they were overtaken by stronger evidence
What are approahces that have weaker evidence ?
Medication, Physical intervention (neuromodulation, leucotomy) and other therapies (DBT, IPT, FIT) Mentalisation-based therpay, ACT, Mindfullness based approahces, family therapies not based on food/eating
How can SSRI medication be used as a intervention for eating disorders?
SSRI medications (e.g., fluoxetine/Prozac) at high doses for BN: Enhances functional serotonin, Reduces binges for some people while taking it, but not for longer, Potential withdrawal effects (‘SSRI discontinuation syndrome’)
How can novel antipsychotic for An be used as intervention for eating disorders?
olanzepine, quetiapine, risperidone. Reduce anxiety?? enhance weight gain through metabolic slowing????
What are two meidcations that are used ?
SSRI and novel antipsychotics
What are some physical interventions that have week evidence
Neuromodulation and leucotomy
What are neuromodulation
Transcanial stimulation methods seem to reduce depression slightly, but no eviednce yet that this work specificall in ED
What are leucotomies?
Brain surgery, rarely used, has been used for chronic anorexia nervosa with extreme OCD, evidence is annecdotal and poor
Other psychological therapies with some evidence (weak)
dialectical behaviour therapy (DBT), Interpersonal psychodynamic approaches (FIT), Focused psychodynamic approaches (FIT), integrative cognitive affective therpy
What is Dialectical behaviour therapy DBT
Reduces impulsive behaviours in BED/BN, but little change in core pathology. Evidence for anorexia nervosa is very limited
What is interpersonal psychotehrapy (IPT)
works for BN, but slower and less effective than CBT
What is Focused psychodynamic approach ?
effective for anorexia nervosa, but needs to be replicated in other countries
Is Integrative cogntiive affective thepry effecitve?
less effective than CBT
What are some Psychological therapies with little evidence so far (despite trying)?
Mentalisation-based therapy, ACT, mindfulness-based appraoches, family therpies that do not focus on food or eating
What is mentalisation based therapy?
Mainly used in personality disorders, effectiveness for eating disorders lower than CBT, takes 18 months
What is ACT
Acceptance and commitment therapy
What are the limitations of deep brain stimulation?
Side effects. Not similarly effective for all. And, crucially, DBS also fails to deal with non-motor symptoms. Confounded by DBS typically being used in later stage disease. It may actually make some non-motor symptoms worse
What are alpha synuclein?
another problematic protein (think back to amyloid with regards to Alzheimer’s disease)
How does Alpha synuclein affect Lewy bodies?
Not sure what it does in health, but it appears that misfolding and aggregation (clumping) into what are called Lewy bodies, is a hallmark of PD
Happens throughout the brain. Dopamine neurons in substantia nigra may be particularly vulnerable. Crucially, this explanation may also account for non-motor symptoms
How does the cerebellar dysfunction?
Like basal ganglia, no direct projection to the lower motor neurons – instead modulate activity of upper motor neurons
What is the cerebellum?
Contains approx. half total number of CNS neurons. Just 10% of total brain weight. Projects to almost all upper motor neurons.
What is dysarthria?
disruption of fine control of speech, slurring
What happens when cerebellum is damaged?
When damaged, the resulting impairment in movement is often described as ataxia. Two types of impairment:
- Disturbances of posture or gait
- Decomposition of movement
Voluntary movement loses fluidity and appears mechanical, slow and robot-like. Intention tremor (not like the PD resting tremor) and Dysarthria
What is ataxia?
A collection of disorders, unified by their symptoms, rather than their causes.
Can be defined most simply as a loss of voluntary co-ordination of muscles – it is thus a neurological finding in a patient, and not a disease (though it may be caused by various diseases)
Types: can be confusing as they are divided up in slightly different ways depending on what source you read
What are the different types of ataxia?
Focusing on types of symptom: cerebellar, sensory, vestibular
Focusing on type of cause: acquired, hereditary, late onset cerebellar dysfunction
Focussing on more detailed diagnosis: Freidrich’s ataxia, ataxia-telangiectasia, spinocerebellar ataxia, episodic ataxia, vitamin-E deficiency related.
What are the different types of distinct symptom pattenrs?
Gait problems, use of proprioceptive ifnor, impaired/altered reflexes (Fredreich’s ataxia)
Ataxia with oculomotor apraxia
Ataxia telangiectasia (rare genetic disorder): nystagmus (eye movement prob)
Oculoot Ataxia: impaired co ordination of eye and head movement
What are motor neuron disease?
Motor neuron degeneration and muscle wasting.
Why muscle wasting? Degenerative, progressive incurable
Causes? ~10% of cases have genetic component – environmental, toxic, viral and other factors implicated in the other 90% - i.e. we don’t know!
What is the motor neuron disease incidence?
Anyone, but more common in men. But risk strongly modulated by age. About 5,000 people in the UK have it right now. Symptoms, rate of progression and life expectancy highly variable.
What are the different types of motor neuron diseases?
MND is used interchangeable with ALS (amyotrophic lateral sclerosis). ALS is subtyp of MND (most common)
SUbtype relates to effect on either upper or lower or both motor neurons.
ALS affects both: all motor neurons, all muscles.
There is often also altered cognitive function (usually mild), ability to communicate, and affective changes
Complications arising due to impaired respiratory function is often the cause of death
What are the treamtent and latest research for motor neuron disease?
Identify biomarkers (early diagnosis)
Identify risk factors
Novel neuroprotective drugs
Gene therapies
Drug to cure, and slow progression
Clinical & technological interventions to improve & prolong life
