A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial A 1-year follow-up of a multi-center treatment trial of adults with anorexia nervosa Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. 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. A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa. Treating severe and enduring anorexia nervosa: a randomized controlled trial. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study. A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Cognitive functioning, weight change and therapy in anorexia nervosa. A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability - the TOuCAN trial. A randomised controlled trial of three psychological treatments for anorexia nervosa. Evaluating an individualized lifestyle and life skills intervention to prevent antipsychotic-induced weight gain in first-episode psychosis.
Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group 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 : 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 IMPORTANCE Anorexia nervosa ( AN ) is a serious disorder with high rates of morbidity and mortality . Family-based treatment ( FBT ) is an evidence -based therapy for adolescent AN , but less than half of those who receive this approach recover . Hence , it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence -based treatment . OBJECTIVE To compare FBT with systemic family therapy ( SyFT ) for the treatment of adolescent-onset AN . DESIGN , SETTING , AND PARTICIPANTS Research in Anorexia Nervosa ( RIAN ) is a 2-group  ( FBT and SyFT ) r and omized trial conducted between September 2005 and April 2012 . Interviewers were blinded to the treatment condition . A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened . Of these , 262 adolescents did not meet the inclusion criteria and 138 declined to participate ; hence , 164 adolescents ( aged 12 - 18 years ) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , AN ( except for amenorrhea ) were enrolled . Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred . INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months . Family-based therapy focuses on the facilitation of weight gain , whereas SyFT addresses general family processes . MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight ( IBW ) and remission ( ≥95 % of IBW ) . The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment ( EOT ) . RESULTS There were no statistically significant differences between treatment groups for the primary outcome , for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up . Remission rates  included FBT , 33.1 % at the EOT and 40.7 % at follow-up and SyFT , 25.3 % and 39.0 % , respectively . Family-based therapy led to significantly faster weight gain early in treatment , significantly fewer days in the hospital , and lower treatment costs per patient in remission at the EOT ( FBT , $ 8963 ; SyFT , $ 18 005 ) . An exploratory moderator analysis found that SyFT led to greater weight gain  than did FBT for participants with more severe obsessive-compulsive symptoms . CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT . Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT . TRIAL REGISTRATION clinical trials.gov Identifier NCT00610753 BACKGROUND Psychotherapy is the treatment of choice for patients with anorexia nervosa , although evidence of efficacy is weak . The Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study aim ed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa -- focal psychodynamic therapy and enhanced cognitive behaviour therapy -- versus optimised treatment as usual . METHODS The ANTOP study is a multicentre , r and omised controlled efficacy trial in adults with anorexia nervosa . We recruited patients from ten university hospitals in Germany . Participants were r and omly allocated to 10 months of treatment with either focal psychodynamic therapy , enhanced cognitive behaviour therapy , or optimised treatment as usual ( including outpatient psychotherapy and structured care from a family doctor ) . The primary outcome was weight gain , measured as increased body-mass index ( BMI ) at the end of treatment . A key secondary outcome was rate of recovery ( based on a combination of weight gain and eating disorder-specific psychopathology ) . Analysis was by intention to treat . This trial is registered at http://is rct n.org , number IS RCT N72809357 . FINDINGS Of 727 adults screened for inclusion , 242 underwent r and omisation : 80 to focal psychodynamic therapy , 80 to enhanced cognitive behaviour therapy , and 82 to optimised treatment as usual . At the end of treatment , 54 patients ( 22 % ) were lost to follow-up , and at 12-month follow-up a total of 73 ( 30 % ) had dropped out . At the end of treatment , BMI had increased in all study groups ( focal psychodynamic therapy 0·73 kg/m(2 ) , enhanced cognitive behaviour therapy 0·93 kg/m(2 ) , optimised treatment as usual 0·69 kg/m(2 ) ) ; no differences were noted between groups ( mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45 , 95 % CI -0·96 to 0·07 ; focal psychodynamic therapy vs optimised treatment as usual -0·14 , -0·68 to 0·39 ; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30 , -0·22 to 0·83 ) . At 12-month follow-up , the mean gain in BMI had risen further ( 1·64 kg/m(2 ) , 1·30 kg/m(2 ) , and 1·22 kg/m(2 ) , respectively ) , but no differences between groups were recorded ( 0·10 , -0·56 to 0·76 ; 0·25 , -0·45 to 0·95 ; 0·15 , -0·54 to 0·83 , respectively ) . No serious adverse events attributable to weight loss or trial participation were recorded . INTERPRETATION Optimised treatment as usual , combining psychotherapy and structured care from a family doctor , should be regarded as solid baseline treatment for adult out patients with anorexia nervosa .  Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up , and enhanced cognitive behaviour therapy  was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology . Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches . FUNDING German Federal Ministry of Education and Research ( Bundesministerium für Bildung und Forschung , BMBF ) , German Eating Disorders Diagnostic and Treatment Network ( EDNET ) Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not 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 This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a st and ard behavioural treatment , in the outpatient therapy of patients with anorexia nervosa . The two treatments were also compared with a control treatment procedure consisting of routine outpatient management .  Each group consisted of eight subjects . All the groups showed some improvement , but the findings did not provide support for the prediction that cognitive-behavioural treatment , design ed specifically to manipulate both attitudes and behaviour , was superior to the other types of treatment . The implication s of the findings are considered 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 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 Adolescents with Anorexia Nervosa ( AN ) , treated with family-based treatment ( FBT )  who fail to gain 2.3 kg by the fourth week of treatment have a 40 - 50 % lower chance of recovery than those who do . Because of the high risk of developing enduring AN , improving outcomes in this group of poor responders is essential . This study examines the feasibility and effects of a novel adaptive treatment ( i.e. , Intensive Parental Coaching-IPC ) aim ed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT . METHOD 45 adolescents ( 12 - 18 years of age ) meeting DSM TR IV criteria for AN were r and omized in an unbalanced design ( 10 to st and ard FBT ; 35 to the adaptive arm ) . Attrition , suitability , expectancy rates , weight change , and psychopathology were compared between groups . OUTCOMES There were no differences in rates of attrition , suitability , expectancy ratings , or most clinical outcomes between r and omized groups . However , the group of poor early responders that received IPC achieved full weight restoration ( > 95 % of expected mean BMI ) by EOT at similar rates as those who had responded early . CONCLUSIONS The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT . The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early . A sufficiently powered study is needed to confirm these promising findings The aim of this study was to compare two forms of outpatient treatment , educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa . Thirty patients were r and omly allocated to the two treatments . At one year , the group had gained 6.8 kg , 19/30 ( 63 % ) had a good or intermediate recovery in terms of nutritional outcome . The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters . In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases . Larger studies will be needed to determine the most effective form of treatment in this group Anorexia nervosa is associated with impairments in cognitive function which have been hypothesized to be fundamentally attentional in nature . The current study investigated whether therapy and weight gain affect these impairments . A group of anorexics ( N = 12 ) completed a battery of cognitive performance tasks and self-report measures of psychopathology on three occasions , over the course of 12 weeks of in-patient treatment .  A non- clinical control population ( N = 17 ) completed the same measures . The anorexics improved on all measures of psychopathology and affective state as a result of therapy . Anorexics displayed poorer recall , reaction times , and motor speed than the control subjects . Although there was a gain in weight over the course of therapy , there was no corresponding improvement in cognitive performance . Impaired task performance in anorexics was not directly related to their psychopathology or affective state 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 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 ) AIM Initiating antipsychotic medication frequently induces rapid , clinical ly significant weight gain . We aim ed to evaluate the effectiveness of a lifestyle and life skills intervention , delivered within 4 weeks of antipsychotic medication initiation , in attenuating weight gain in youth aged 14 - 25 years with first-episode psychosis ( FEP ) . METHODS We undertook a prospect i ve , controlled study in two early psychosis community services . Intervention participants ( n = 16 ) received a 12-week individualized intervention delivered by specialist clinical staff ( nurse , dietician and exercise physiologist ) and youth peer wellness coaches , in addition to st and ard care . A comparison group was recruited from a similar service and received st and ard care  ( n = 12 ) . RESULTS The intervention group experienced significantly less weight gain at 12 weeks compared to st and ard care ( 1.8 kg , 95 % CI -0.4 to 2.8 vs. 7.8 kg , 4.8 - 10.7 , P < 0.001 ) . Thirteen per cent ( 2/16 ) of the intervention group experienced clinical ly significant weight gain ( greater than 7 % of baseline weight ) , while 75 % ( 9/12 ) of the st and ard care group experienced this level of weight gain . Similar positive effects of the intervention were observed for waist circumference . CONCLUSIONS A lifestyle and life skills intervention delivered as part of st and ard care attenuated antipsychotic-induced weight gain in young people with FEP . The intervention was acceptable to the young people referred to the service . Such interventions may prevent the seeding of future disease risk and in the long-term help reduce the life expectancy gap for people living with serious mental illness
There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .