Behavioral interventions for antipsychotic medication-associated obesity: a randomized, controlled clinical trial. Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive-behavioural therapy in out-patients with anorexia nervosa. A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. A 1-year follow-up of a multi-center treatment trial of adults with anorexia nervosa Treating severe and enduring anorexia nervosa: a randomized controlled trial. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial Three psychotherapies for anorexia nervosa: a randomized, controlled trial. TECNOB Study: Ad Interim Results of a Randomized Controlled Trial of a Multidisciplinary Telecare Intervention for Obese Patients with Type-2 Diabetes A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability - the TOuCAN trial. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Intensive enhanced cognitive behavioural therapy for severe and enduring anorexia nervosa: A longitudinal outcome study. Anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex improves anorexia nervosa: A pilot study. Clinical effectiveness of a skills training intervention for caregivers in improving patient and caregiver health following in-patient treatment for severe anorexia nervosa: pragmatic randomised controlled trial A randomised controlled trial of three psychological treatments for anorexia nervosa. Internet-Based Cognitive-Behavioral Therapy for Bulimia Nervosa: A Controlled Study A randomized controlled trial of internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population.
OBJECTIVE To demonstrate the effectiveness of a Diabetes Prevention Program-inspired 12-month behavioral intervention for patients with severe mental illness ( SMI ) and medication-associated obesity . METHOD This r and omized , controlled , parallel , superiority study screened 225 volunteers from November 2005 to August 2008 at the VA Greater Los Angeles Healthcare System . 122 out patients with DSM-IV-diagnosed SMI taking antipsychotic medications who had ≥ 7 % weight gain or body mass index ( BMI ) > 25 were r and omized by computer-generated number to Lifestyle Balance treatment intervention  ( n = 60 ) or usual care control  ( n = 62 ) groups . Clinical raters were masked to r and omization . Treatment intervention included weekly classes and individual counseling for 8 weeks , food and exercise diaries , rewards , caregiver consultations , and monthly booster classes and counseling for 1 year . Controls received self-help material s and visited at equivalent intervals without formal classes or counseling . Outcomes were changes in anthropometric measurements , psychiatric symptoms , health knowledge , and glucose , hemoglobin A1c , and lipid levels . RESULTS Our intention-to-treat analysis found significant differences in predicted trajectory of mean weight change between the groups over 12 months ( P < .01 ) , with treatment participants expected to lose an average 4.6 kg , while control participants would gain an average 0.6 kg . BMI and body fat percentage followed the same pattern . Both groups demonstrated statistically significant improvements in health knowledge quiz scores over time ( P = .006 ) , without significant difference between groups . CONCLUSIONS Treatment was more effective than usual care control in treating medication-associated obesity , independent of SMI diagnosis , antipsychotic medication , and knowledge gained , suggesting that behavioral interventions are effective in SMI patients . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00344500 BACKGROUND Anorexia nervosa ( AN ) is a serious illness leading to substantial morbidity and mortality . The treatment of AN very often is protracted ; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system . Therefore , this study aim ed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy ( FPT ) , enhanced cognitive-behavioural therapy ( CBT-E ) , and optimized treatment as usual ( TAU-O ) in the treatment of adult women with AN . METHOD The analysis was conducted alongside the r and omized controlled Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study . Cost-effectiveness was determined using direct costs per recovery at 22 months post-r and omization ( n = 156 ) . Unadjusted incremental cost-effectiveness ratios ( ICERs ) were calculated . To derive cost-effectiveness acceptability curves ( CEACs ) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay ( WTP ) per additional recovery . Cost-utility and assumptions underlying the base case were investigated in exploratory analyses . RESULTS Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups . The unadjusted ICERs  indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover , FPT was dominant compared with CBT-E.  CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95 % if the WTP per recovery was ⩾€9825 and ⩾€24 550 , respectively . Comparing CBT-E with TAU-O , the probability of being cost-effective remained < 90 % for all WTPs . The exploratory analyses showed similar but less pronounced trends . CONCLUSIONS Depending on the WTP , FPT proved cost-effective in the treatment of adult AN Research on treatments in anorexia nervosa ( AN ) is scarce . Although most of the therapeutic programs used in ‘ real world practice ’ in AN treatment resort to multidisciplinary approaches , they have rarely been evaluated . Objective To compare two multidimensional post-hospitalization out patients treatment programs for adolescents with severe AN :  Treatment as Usual ( TAU ) versus this treatment plus family therapy ( TAU+FT ) . Method Sixty female AN adolescents , aged 13 to 19 years , were included in a r and omized parallel controlled trial conducted from 1999 to 2002 for the recruitment , and until 2004 for the 18 months follow-up . Allocation to one of the two treatment groups ( 30 in each arm ) was r and omised . The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents . The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics , but not eating disorder symptoms . The main Outcome Measure was the Morgan and Russell outcome category ( Good or Intermediate versus Poor outcome ) . Secondary outcome indicators included AN symptoms or their consequences ( eating symptoms , body mass index , amenorrhea , number of hospitalizations in the course of follow-up , social adjustment ) . The evaluators , but not participants , were blind to r and omization . Results At 18 months follow-up , we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy ( Intention-to-treat : TAU+FT : 12/30 ( 40 % ) ; TAU : 5/29 ( 17.2 % ) p = 0.05 ; Per Protocol analysis : respectively 12/26 ( 46.2 % ) ; 4/27 ( 14.8 % ) , p = 0.01 ) . Similar group effects were observed in terms of achievement of a healthy weight ( i.e. , BMI ≥10th percentile ) and menstrual status . Conclusions Adding family therapy sessions , focusing on intra-familial dynamics rather than eating symptomatology , to a multidimensional program improves treatment effectiveness in girls with severe AN . Trial Registration Controlled-trials.com IS RCT CONTEXT Evidence -based treatment trials for adolescents with anorexia nervosa are few . OBJECTIVE To evaluate the relative efficacy of family-based treatment ( FBT ) and adolescent-focused individual therapy ( AFT ) for adolescents with anorexia nervosa in full remission . DESIGN R and omized controlled trial . SETTING Stanford University and The University of Chicago ( April 2005 until March 2009 ) . PARTICIPANTS One hundred twenty-one participants , aged 12 through 18 years , with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement . Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT . Participants were assessed at baseline , end of treatment ( EOT ) , and 6 months ' and 12 months ' follow-up posttreatment . MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight ( ≥95 % of expected for sex , age , and height ) and mean global Eating Disorder Examination score within 1 SD of published means . Secondary outcome measures included partial remission rates ( > 85 % of expected weight for height plus those who were in full remission ) and changes in body mass index percentile and eating-related psychopathology . RESULTS There were no differences in full remission between treatments at EOT . However , at both the 6- and 12-month follow-up , FBT was significantly superior to AFT on this measure . Family-based treatment was significantly superior for partial remission at EOT but not at follow-up . In addition , body mass index percentile at EOT was significantly superior for FBT , but this effect was not found at follow-up . Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT , but there were no differences at follow-up . CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT , FBT was more effective in facilitating full remission at both follow-up points . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00149786 OBJECTIVE : To examine maintenance of recovery following treatment in an adult anorexia nervosa ( AN ) population . METHOD : One year follow-up of a r and omized clinical trial with 122 participants treated with : cognitive behavioral therapy ( CBT ) , drug therapy ( fluoxetine ) , or a combination ( CBT+fluoxetine ) for 12 months . Participants were assessed at baseline , end of treatment , and follow-up . The primary outcomes were weight and the global scores from the Eating Disorder Examination ( EDE ) separately and combined . RESULTS : Fifty-two participants completed the follow-up . Mean weight increased from end of treatment to follow-up . Seventy-five percent ( 75 % ) of those weight recovered at end of treatment maintained this recovery at follow-up . Recovery of eating disorder psychopathology was stable from end of treatment to follow-up , with 40 % of participants with a global EDE score within normal range . Using the most stringent criteria for recovery , only 21 % of the completer sample was recovered . DISCUSSION : The findings suggest that while adults with AN improve with treatment and maintain these improvements during follow-up , the majority is not recovered . Additionally , further research is needed to underst and barriers to treatment and assessment completion BACKGROUND There are no evidence -based treatments for severe and enduring anorexia nervosa ( SE-AN ) . This study evaluated the relative efficacy of cognitive behavioral therapy ( CBT-AN ) and specialist supportive clinical management ( SSCM ) for adults with SE-AN . METHOD Sixty-three participants with a diagnosis of AN , who had at least a 7-year illness history , were treated in a multi-site r and omized controlled trial ( RCT ) . During 30 out-patient visits spread over 8 months , they received either CBT-AN or SSCM , both modified for SE-AN . Participants were assessed at baseline , end of treatment ( EOT ) , and at 6- and 12-month post-treatment follow-ups . The main outcome measures were quality of life , mood disorder symptoms and social adjustment . Weight , eating disorder ( ED ) psychopathology , motivation for change and health-care burden were secondary outcomes . RESULTS Thirty-one participants were r and omized to CBT-AN and 32 to SSCM with a retention rate of 85 % achieved at the end of the study . At EOT and follow-up , both groups showed significant improvement . There were no differences between treatment groups at EOT . At the 6-month follow-up , CBT-AN participants had higher scores on the Weissman Social Adjustment Scale ( WSAS ; p = 0.038 ) and at 12 months they had lower Eating Disorder Examination ( EDE ) global scores ( p = 0.004 ) and higher readiness for recovery ( p = 0.013 ) compared to SSCM . CONCLUSIONS Patients with SE-AN can make meaningful improvements with both therapies . Both treatments were acceptable and high retention rates at follow-up were achieved . Between-group differences at follow-up were consistent with the nature of the treatments given Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide . The seriousness of the disorder requires extensive knowledge of effective treatment options . However , evidence for treatment efficacy in this area is remarkably weak . A recent Cochrane review states that there is an urgent need for large , well- design ed treatment studies for patients with anorexia nervosa . The aim of this particular multi-centre study is to evaluate the efficacy of two st and ardized outpatient treatments for patients with anorexia nervosa :  focal psychodynamic ( FPT ) and cognitive behavioural therapy ( CBT ) . Each therapeutic approach is compared to a " treatment-as-usual " control group . Methods / Design 237 patients meeting eligibility criteria are r and omly and evenly assigned to the three groups – two intervention groups ( CBT and FPT ) and one control group . The treatment period for each intervention group is 10 months , consisting of 40 sessions respectively . Body weight , eating disorder related symptoms , and variables of therapeutic alliance are measured during the course of treatment . Psychotherapy sessions are audiotaped for adherence monitoring . The treatment in the control group , both the dosage and type of therapy , is not regulated in the study protocol , but rather reflects the current practice of established outpatient care . The primary outcome measure is the body mass index ( BMI ) at the end of the treatment ( 10 months after r and omization ) . Discussion The study design surmounts the disadvantages of previous studies in that it provides a r and omized controlled design , a large sample size , adequate inclusion criteria , an adequate treatment protocol , and a clear separation of the treatment conditions in order to avoid contamination . Nevertheless , the study has to deal with difficulties specific to the psychopathology of anorexia nervosa . The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol . However , because patients are difficult to recruit and often ambivalent about treatment , a drop-out rate of 30 % is assumed for sample size calculation . Due to the ethical problem of denying active treatment to patients with anorexia nervosa , the control group is defined as " treatment-as-usual".Trial registration Current Controlled Trials IS RCT OBJECTIVE Few r and omized , controlled trials have examined the efficacy of treatments for anorexia nervosa .  Cognitive behavior therapy and interpersonal psychotherapy are effective in a related disorder , bulimia nervosa . There are theoretical and treatment indications for these therapies in anorexia nervosa . METHOD Fifty-six women with anorexia nervosa diagnosed by using strict and lenient weight criteria were r and omly assigned to three treatments . Two were specialized psychotherapies ( cognitive behavior therapy and interpersonal psychotherapy ) , and one was a control treatment combining clinical management and supportive psychotherapy ( nonspecific supportive clinical management ) . Therapy consisted of 20 sessions over a minimum of 20 weeks . RESULTS For the total study group ( intent-to-treat group ) , there were significant differences among therapies in the primary global outcome measure . Nonspecific supportive clinical management was superior to interpersonal psychotherapy , while cognitive behavior therapy was intermediate , neither worse than nonspecific supportive clinical management nor better than interpersonal psychotherapy . For the women completing therapy , nonspecific supportive clinical management was superior to the two specialized therapies . CONCLUSIONS The finding that nonspecific supportive clinical management was superior to more specialized psychotherapies was opposite to the primary hypothesis and challenges assumptions about the effective ingredients of successful treatments for anorexia nervosa Background : Obesity increases the risk of many health complications such as hypertension , coronary heart disease and type 2 diabetes , needs long-lasting treatment for effective results and involves high public and private care-costs . Therefore , it is imperative that enduring and low-cost clinical programs for obesity and related co-morbidities are developed and evaluated . Information and communication technologies ( ICT ) can help clinicians to deliver treatment in a cost-effective and time-saving manner to a large number of obese individuals with co-morbidities . Objective : To examine ad interim effectiveness of a 12-month multidisciplinary telecare intervention for weight loss provided to obese patients with type 2 diabetes . Design , Setting , and Participants : A single-center r and omized controlled trial ( TECNOB study ) started in December 2008 . At present , 72 obese patients with type 2 diabetes have been recruited and r and omly allocated to the TECNOB program ( n=37 ) or to a control condition ( n=39 ) . However , only 34 participants have completed at least the 3-month follow-up and have been included in this ad interim analysis . 21 out of them have reached also the 6-month follow-up and 13 have achieved the end of the program . Study is still on-going . Intervention : All participants attended 1-month inpatient intensive program that involved individualized medical care , diet therapy , physical training and brief psychological counseling . At discharge , participants allocated to the TECNOB program were instructed to use a  weight-loss web-site  , a web-based videoconference tool , a dietary software installed into their cellular phones and an electronic armb and measuring daily steps and energy expenditure . Main Outcome Measures : Weight and disordered eating-related behaviors and cognitions ( EDI-2 ) at entry to hospital , at discharge from hospital , at 3,6 and 12 months . Results : Ad interim analysis of data from 34 participants showed no statistically significant difference between groups in weight change at any time-point . However , within-group analysis revealed significant reductions of initial weight at discharge from hospital , at 3 months , at 6 months but not at 12 months . Control group had higher scores in Interpersonal distrust at 12 months . Conclusion : This ad interim findings revealed that the effect of the inpatient treatment was high and probably overwhelmed the effect of the TECNOB intervention . Much statistical power and long-term follow-up may enhance the probability to detect the TECNOB effect over and above the great one exerted by the inpatient program OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of inpatient compared with outpatient treatment and general ( routine ) treatment in Child and Adolescent Mental Health Services ( CAMHS ) against specialist treatment for young people with anorexia nervosa . In addition , to determine young people 's and their carers ' satisfaction with these treatments . DESIGN A population -based , pragmatic r and omised controlled trial ( RCT ) was carried out on young people age 12 to 18 presenting to community CAMHS with anorexia nervosa . SETTING Thirty-five English CAMHS in the north-west of Engl and co-ordinated through specialist centres in Manchester and Liverpool . PARTICIPANTS Two hundred and fifteen young people ( 199 female ) were identified , of whom 167 ( mean age 14 years 11 months ) were r and omised and 48 were followed up as a preference group . INTERVENTIONS R and omised patients were allocated to either inpatient treatment in one of four units with considerable experience in the treatment of anorexia nervosa , a specialist outpatient programme delivered in one of two centres , or treatment as usual in general community CAMHS . The outpatient programmes spanned 6 months of treatment . The length of inpatient treatment was determined on a case-by-case basis on clinical need with outpatient follow-up to a minimum of 6 months . MAIN OUTCOME MEASURES Follow-up assessment s were carried out at 1 , 2 and 5 years . The primary outcome measure was the Morgan-Russell Average Outcome Scale ( MRAOS ) and associated categorical outcomes . Secondary outcome measures included physical measures of weight , height , body mass index ( BMI ) and % weight for height . Research ratings included the Health of the National Outcome Scale for Children and Adolescents ( HoNOSCA ) . Self report measures comprised the user version of HoNOSCA ( HoNOSCA-SR ) , the Eating Disorder Inventory 2 ( EDI-2 ) , the Family Assessment Device ( FAD ) and the recent Mood and Feelings Question naire ( MFQ ) . Information on re source use was collected in interview at 1 , 2 and 5 years using the Child and Adolescent Service Use Schedule ( CA-SUS ) . Satisfaction was measured quantitatively using a question naire design ed for the study and qualitative ( free ) responses on it . The question naire data were supplemented by qualitative analysis of user and carer focus groups . RESULTS Of the 167 patients r and omised , 65 % adhered to the allocated treatment . Adherence was lower for inpatient treatment ( 49 % ) than for general CAMHS ( 71 % ) or specialist outpatient treatment ( 77 % ) ( p = 0.013 ) . Every subject was traced at both 1 and 2 years , with the main outcome measure completed ( through contact with the subject , family members or clinicians ) , by 94 % at 1 year , 93 % at 2 years , but only 47 % at 5 years . A vali date d outcome category was assigned for 98 % at 1 year , 96 % at 2 years and 60 % at 5 years . There was significant improvement in all groups at each time point , with the number achieving a good outcome being 19 % at 1 year , 33 % at 2 years and 64 % ( of those followed up ) at 5 years . Analysis demonstrated no difference in treatment effectiveness of r and omisation to inpatient compared with outpatient treatment , or , specialist over generalist treatment at any time point , when baseline characteristics were taken into account . Generalist CAMHS treatment was slightly more expensive over the first 2 years of the study , largely because greater numbers were subsequently admitted to hospital after the initial treatment phase . The specialist outpatient programme was the dominant treatment in terms of incremental cost-effectiveness . Specialist treatments had a higher probability of being more cost-effective than generalist treatments and outpatient treatment had a higher probability of being more cost-effective than inpatient care .  Parental satisfaction with treatment was generally good , though better with specialist than generalist treatment .  Young people  's satisfaction was much more mixed , but again better with specialist treatment , including inpatient care . CONCLUSION Poor adherence to r and omisation ( despite initial consent to it ) , limits the assessment of the treatment effect of inpatient care . However , this study provides little support for lengthy inpatient psychiatric treatment on clinical or health economic grounds . These findings are broadly consistent with existing guidelines on the treatment of anorexia nervosa , which suggest that outpatient treatments should be offered to the majority , with inpatient treatment offered in rare cases , though our findings lend little support to a stepped-care approach in which inpatient care is offered to outpatient non-responders . Outpatient care , supported by brief ( medical ) inpatient management for correction of acute complications may be a preferable approach . The health economic analysis and user views both support NICE guidelines , which suggest that anorexia nervosa should be managed in specialist services that have experience and expertise in its management . Comprehensive general CAMHS might , however , be well placed to manage milder cases . Further research should focus on the specific components of outpatient psychological therapies . Although family-based treatments are well established , trials have not established their effectiveness compared with good- quality individual psychological therapies and the combination of individual and family approaches is untested . Further research is needed to establish which patients ( if any ) might respond to inpatient psychiatric treatment when unresponsive to outpatient care , the positive and negative components of it and the optimum length of stay . TRIAL REGISTRATION NRR number ( National Research Register ) N0484056615 ; Current Controlled Trials IS RCT N39345394 BACKGROUND This study aims to assess changes in core eating disorder psychopathology ( Eating Attitudes Test , EAT ; Eating Disorders Inventory-2 , EDI-2 ) , depression ( Hamilton Rating Scale , HRSD ; Beck Depression Inventory , BDI ) and general psychopathology ( MMPI-2 ) after inpatient treatment and one-year follow-up among patients diagnosed with anorexia . METHODS Thirty-two patients were treated for anorexia nervosa on an inpatient unit , and were assessed before and after treatment . The inpatient milieu was design ed to use cognitive therapy as the primary therapeutic intervention , along with weight restoration . RESULTS At discharge , all patients displayed significant change in core eating disorder psychopathology in their depressive symptoms , as well as in general aspects of psychopathology . At one-year follow-up , changes in some areas of core eating disorder psychopathology and depressive symptoms continued to be significantly different than from admissions . CONCLUSIONS The combination of CBT and weight restoration can significantly reduce eating disorder symptoms , depression , and general psychopathology during hospitalization , with some sustained benefit over a one year period . Future research is needed to identify the effect of CBT on anorexia nervosa during a wide variety of treatment setting s. Also , research must focus on the influence of outpatient treatment in the outcome of anorexia nervosa OBJECTIVE This study aim ed to evaluate short- and long-term outcomes in patients with severe and enduring anorexia nervosa ( SE-AN ) , as compared with those with non SE-AN ( NSE-AN ) , both treated via an inpatient programme based on a " recovery model " approach . METHODS Sixty-six adult patients with anorexia nervosa ( AN ) were recruited from among consecutive referrals to a community-based eating disorder clinic offering inpatient enhanced cognitive behavioural therapy for eating disorders ( CBT-E ) . Body mass index ( BMI ) , and Eating Disorder Examination ( EDE ) and Brief Symptom Inventory ( BSI ) scores were recorded at admission , at the end of treatment , and at 6- and 12-month follow-ups . RESULTS Thirty-two patients ( 48.5 % ) were classified as SE-AN ( i.e. , duration of illness > 7 years ) , and 34 ( 51.5 % ) as NSE-AN . During the treatment , both groups displayed similarly large increases in BMI , as well as improvements in eating-disorder and general psychopathology . After discharge minor deterioration did occur , but both NSE-AN and SE-AN groups showed similar rates of ' good BMI outcome ' ( BM ≥ 18.5 ; 44.0 % and 40.7 % , respectively ) and ' full response ' ( BMI ≥ 18.5 and minimal eating-disorder psychopathology ; 32.0 % and 33.3 % , respectively ) at 12-month follow-up . CONCLUSIONS These findings suggest that inpatient CBT-E is well accepted by patients with AN , and could also be a viable and promising treatment for those with SE-AN BACKGROUND Existing treatments for adults with anorexia nervosa ( AN ) have limited proven efficacy . New treatments that have been suggested involve targeted , brain-directed interventions such as transcranial direct current stimulation ( tDCS ) . We describe findings from seven individuals with treatment-resistant AN who received 10 sessions of anodal tDCS , over the left dorsolateral prefrontal cortex ( DLPFC ) . MATERIAL AND METHOD In this open-label , single-arm study , seven patients received  anodal tDCS ( 2mA ) for 25 minutes over the left dorsolateral prefrontal cortex daily for ten days . Assessment s pre-tDCS , post-tDCS and one month later included the Eating Attitude Test ( EAT ) , Eating Disorder Inventory ( EDI ) and Beck Depression Inventory ( BDI ) . RESULTS Three patients improved in all three rating scales immediately after the treatment sessions and one month later . Two patients showed improvement at the end of treatment but returned to the baseline after one month . One subject improved only on the BDI scale but not eating scales . The scores in the three rating scales were unaffected by treatment in the remaining patient . There was a significant effect of time ( pre , post and 1 month later ) on the three rating scores ; BDI ( P = 0.016 ) , EDI ( P = 0.018 ) and EAT ( P = 0.016 ) and a significant correlation between the percent improvement of BDI and EAT ( p = 0.01 ) , and between BDI and EDI ( P = 0.006 ) . CONCLUSIONS These findings suggest that tDCS has potential as an adjuvant treatment for AN and deserves further study Background Families express a need for information to support people with severe anorexia nervosa . Aims To examine the impact of the addition of a skills training intervention for caregivers ( Experienced Caregivers Helping Others , ECHO ) to st and ard care . Method Patients over the age of 12 ( mean age 26 years , duration 72 months illness ) with a primary diagnosis of anorexia nervosa and their caregivers were recruited from 15 in-patient services in the UK . Families were r and omised to ECHO ( a book , DVDs and five coaching sessions per caregiver ) or treatment as usual .  Patient ( n=178 ) and caregiver ( n=268 ) outcomes were measured at discharge and 6 and 12 months after discharge . Results Patients with caregivers in the  ECHO group had reduced eating disorder psychopathology ( EDE-Q ) and improved quality of life ( WHO-Quol ; both effects small ) and reduced in-patient bed days ( 7–12 months post-discharge ) . Caregivers in the ECHO group had reduced burden ( Eating Disorder Symptom Impact Scale , EDSIS ) , expressed emotion ( Family Question naire , FQ ) and time spent caregiving at 6 months but these effects were diminished at 12 months . Conclusions Small but sustained improvements in symptoms and bed use are seen in the intervention group . Moreover , caregivers were less burdened and spent less time providing care . Caregivers had most benefit at 6 months suggesting that booster sessions , perhaps jointly with the patients , may be needed to maintain the effect . Sharing skills and information with caregivers may be an effective way to improve outcomes . This r and omised controlled trial ( RCT ) was registered with Current Controlled Trials IS RCT N06149665 . Declaration of interest J.T. is a co-author of the book used in the ECHO intervention and receives royalties . Copyright and usage © The Royal College of Psychiatrists 2015 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence BACKGROUND There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa ( AN ) . The aim of this study was to compare three psychological treatments for AN : Specialist Supportive Clinical Management , Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy . METHOD A multi-centre r and omised controlled trial was conducted with outcomes assessed at pre- , mid- and post-treatment , and 6- and 12-month follow-up by research ers blind to treatment allocation . All analyses were intention-to-treat . One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment setting s in three Australian cities and offered 25 - 40 sessions over a 10-month period . Primary outcomes were body mass index ( BMI ) and eating disorder psychopathology . Secondary outcomes included depression , anxiety , stress and psychosocial impairment . RESULTS Treatment was completed by 60 % of participants and 52.5 % of the total sample completed 12-month follow-up . Completion rates did not differ between treatments . There were no significant differences between treatments on continuous outcomes ; all result ed in clinical ly significant improvements in BMI , eating disorder psychopathology , general psychopathology and psychosocial impairment that were maintained over follow-up . There were no significant differences between treatments with regard to the achievement of a healthy weight ( mean = 50 % ) or remission ( mean = 28.3 % ) at 12-month follow-up . CONCLUSION The findings add to the evidence base for these three psychological treatments for adults with AN , but the results underscore the need for continued efforts to improve outpatient treatments for this disorder . Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN 12611000725965 ) The object of this study was to examine the effectiveness of an Internet-based therapy ( IBT ) for bulimia nervosa ( BN ) as compared to a waiting list ( WL ) .  Sixty-two female BN patients , diagnosed according to DSM-IV criteria , were assigned to either the IBT or a WL .  The control participants ( WL ) were matched to the IBT  group in terms of age , duration of the disorder , number of previous treatments , and severity of the disorder . Assessment measures included the EDI , SCL-90-R , BITE , the TCI-R , and other clinical and psychopathological indices , which were administrated before and after the treatment . Considering the IBT , while the mean scores were lower at the end of the treatment for some EDI scales ( bulimic , interpersonal distrust , maturity fears , and total score ) and the BITE symptomatology subscale , the mean BMI was higher at posttherapy . Predictors of good IBT outcome were higher scores on the EDI perfectionism scale and EAT and a higher minimum BMI . Drop-out ( after IBT 35.5 % of cases ) was related to higher SCL-anxiety scores , a lower hyperactivity , a lower minimum BMI , and lower TCI-reward dependence scores . At the end of the treatment , bingeing and vomiting abstinence rates differed significantly between the two groups . Results suggest that an online self-help approach appears to be a valid treatment option for BN when compared to a WL control group , especially for people who present a lower severity of their eating disorder ( ED ) symptomatology and some specific personality traits BACKGROUND Bulimic eating disorders are common among female students , yet the majority do not access effective treatment . Internet-based cognitive-behavioural therapy ( iCBT ) may be able to bridge this gap . METHOD Seventy-six students with bulimia nervosa ( BN ) or eating disorder not otherwise specified ( EDNOS ) were r and omly assigned to immediate iCBT with e-mail support over 3 months or to a 3-month waiting list followed by iCBT [ waiting list/delayed treatment control ( WL/DTC ) ] . ED outcomes were assessed with the Eating Disorder Examination ( EDE ) at baseline , 3 months and 6 months . Other outcomes included depression , anxiety and quality of life . RESULTS Students who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms . CONCLUSIONS iCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects
Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration , although its efficacy in the underweight state remains unknown .
Variants of family therapy are efficacious in adolescents , but not in adults .
Evidence for AN treatment is weak ; evidence for treatment-related harms and factors associated with efficacy of treatment are weak ; and evidence for differential outcome by sociodemographic factors is nonexistent .
OBJECTIVE The RTI International-University of North Carolina at Chapel Hill Evidence -based Practice Center ( RTI-UNC EPC ) systematic ally review ed evidence on efficacy of treatment for anorexia nervosa ( AN ) , harms associated with treatments , factors associated with treatment efficacy , and differential outcome by sociodemographic characteristics .