Naturalistic follow-up of subjects affected with anorexia nervosa 8 years after multimodal treatment: Personality and psychopathology changes and predictors of outcome

AbstractBackground:Eating disorders (EDs) are serious mental illnesses of growing clinical and social impact. Despite their severity, there is still no satisfactory evidence-based treatment. Follow-up investigations are the most reliable studies to enlighten long-term outcome predictors and modifiers.Methods:In total, 59 subjects affected with anorexia nervosa were assessed 8 years after their admission into an outpatient multimodal treatment program for eating disorders. The follow-up changes in diagnostic criteria were compared with Chi-square test. Improved and not-improved subjects were compared. Clinical, personality and psychopathology features between T0 and T1 were compared with t-test for repeated measures. Correlation between T0 features and changes at T1 in personality and psychopathology features were assessed.Results:The rate of complete remission was 42%, an overall rate of 67.8% improved, a rate of 18.6% worsened. Concerning personality, a significant decrease of harm avoidance and increase in self-directedness were evidenced. Interoceptive awareness, drive for thinness, bulimia were significantly reduced at follow-up. Many T0 personality facets were related to personality and psychopathology improvement at follow-up.Conclusion:Multimodal treatment encompassing psychiatric, nutritional and psychological approaches is at the moment the most reliable approach for the treatment of moderate to severe anorexia nervosa with a discrete rate of improvement. Some personality and psychopathology characteristics may represent specific factors which favor resistance and impair improvement. Future approaches should consider the personalization of therapeutic approach according to these features.

Download Full-text

ANOREXIA NERVOSA

PEDIATRICS ◽

10.1542/peds.70.4.525 ◽

1982 ◽

Vol 70 (4) ◽

pp. 525-525

Author(s):

Robert J. Haggerty

Keyword(s):

Anorexia Nervosa ◽

Early Onset ◽

Age Of Onset ◽

Outcome Studies ◽

Psychosomatic Disorder ◽

Term Outcome ◽

Long Term Outcome ◽

Follow Up Studies

Anorexia nervosa is a serious psychosomatic disorder which most typically begins between 16 and 18 years of age. Clinicians have often held that early onset (eg, ages 11 to 15) is associated with a better outcome. This paper reviews the long-term outcome studies on anorexia nervosa and concludes that this contention is not supported by available data. The methodologies of seven outcome studies that focus on an early onset population are critiqued, and it is concluded that two methodologies are strong. Because of the increasing prevalence of anorexia nervosa, this once rare disorder can now be more easily investigated, and consequently better follow-up studies, which examine potential prognostic factors including age of onset, should be forthcoming.

Download Full-text

Impulsivity and Eating Disorders

The British Journal of Psychiatry ◽

10.1192/bjp.162.2.193 ◽

1993 ◽

Vol 162 (2) ◽

pp. 193-197 ◽

Cited By ~ 108

Author(s):

Thomas Fahy ◽

Ivan Eisler

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Treatment Trial ◽

Eating Disturbance ◽

Distinct Subgroup ◽

Impulsive Behaviour ◽

Poor Treatment ◽

One Year ◽

Poor Treatment Response

Sixty-seven patients with bulimia nervosa and 29 patients with anorexia nervosa completed the Impulsiveness Questionnaire and questionnaires detailing severity of eating disorder. Bulimic patients had higher impulsivity scores than anorexic patients. Bulimics with high impulsivity scores did not have more severe eating disorders than low scorers. When 39 bulimics and 25 anorexics were interviewed about other impulsive behaviour, 51 % of bulimics and 28% of anorexics reported at least one other impulsive behaviour. Patients with so-called ‘multiimpulsive’ bulimia reported more severe eating disturbance, but this was not reflected on more reliable measures of symptoms. Thirty-nine bulimics entered an eight-week treatment trial and their progress was assessed at eight weeks, 16 weeks and one year. ‘Non-impulsive’ bulimics had a more rapid response than ‘impulsives' during treatment, but there was no difference at follow-up. There was no evidence of an association between high impulsivity trait scores and poor treatment response. It is concluded that impulsivity may shape the expression of eating disorders, but that ‘multi-impulsives' do not constitute a categorically distinct subgroup of bulimics.

Download Full-text

Long-term outcome and psychiatric comorbidity of adolescent-onset anorexia nervosa

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104519827629 ◽

2019 ◽

Vol 25 (1) ◽

pp. 33-44 ◽

Cited By ~ 7

Author(s):

Susana Andrés-Pepiñá ◽

Maria Teresa Plana ◽

Itziar Flamarique ◽

Sonia Romero ◽

Roger Borràs ◽

...

Keyword(s):

Anorexia Nervosa ◽

Control Group ◽

Term Outcome ◽

Long Term Outcome ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Increased Risk ◽

A Current

Objective: To assess the outcome of adolescents with anorexia nervosa (AN) about 20 years after first treatment. Methods: Sixty-two women diagnosed with AN during adolescence were invited to participate. Of these 62 patients, 38 agreed to participate and were assessed with a battery of questionnaires and interviews. A control group of 30 women of similar age was also assessed. Results: Of the patients who completed the full assessment, 13 (34%) presented some degree of eating disorder (ED) at follow-up (10 (26%) met full Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for an ED and 3 (8%) showed partial remission of an ED). The remaining 25 (66%) patients had fully recovered from AN. The duration of untreated illness before admission was significantly associated with an increased risk of a current ED (odds ratio (OR) = 3.334 (1.3–8.7); p = .014). Of the patients who had recovered totally from their ED, 24% showed another psychiatric disorder. This percentage rose to 70% in patients with a current ED. Conclusion: Sixty-six percent of adolescents who completed the assessment achieved remission of their AN. Comorbidity was more common in the current ED group. The variable that best predicted complete remission was the number of years without treatment, showing the importance of detection and early intervention.

Download Full-text

Down's Syndrome and Eating Disorders

The British Journal of Psychiatry ◽

10.1192/bjp.152.6.847 ◽

1988 ◽

Vol 152 (6) ◽

pp. 847-848 ◽

Cited By ~ 12

Author(s):

G. M. Holt ◽

N. Bouras ◽

J. P. Watson

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Clinical Symptoms ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Patient Treatment

We describe the case of a 33-year-old man with Down's syndrome and severe eating disorders. The clinical symptoms, and their difference from those of anorexia nervosa, are discussed. The patient responded well to a strict behavioural programme after long, in-patient treatment and was still well at a 2-year follow-up examination.

Download Full-text

Abstract W MP105: Long Term Stroke Outcome and Caregiving Among Mexican Americans (MA) and Non-Hispanic Whites (NHW): The Population-Based Brain Attack Surveillance in Corpus Christi (BASIC) Study

Stroke ◽

10.1161/str.45.suppl_1.wmp105 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Brisa N Sanchez ◽

Lynda Lisabeth ◽

Darin Zahuranec ◽

Melinda A Cox ◽

Nelda Garcia ◽

...

Keyword(s):

Functional Outcome ◽

Repeated Measures ◽

Mexican Americans ◽

Caregiver Strain ◽

Stroke Survivors ◽

Basic Study ◽

Long Term Outcome ◽

Post Stroke

Background: Long term stroke outcomes in MA are understudied, and the role of informal caregiving and caregiver strain in this population is unknown. We report a pilot study of long-term outcomes in BASIC. Methods: Patients previously interviewed at 90 days post-stroke were invited to participate in a telephone survey related to their 6 or 12 month post-stroke activities of daily living (ADLs) during March-May 2013. ADL score (average of 7 items, range 1-4) was analyzed by self-reported ethnicity using repeated measures models. In a separate sample interviewed at 90 days, patients were asked about willingness to participate in longer term follow-up and a subset of caregivers responded to the caregiver strain index (CSI, range 1-13, higher is worse). Results: Among patients alive at the time of interview, 87% of 39 MA and 74% of 19 NHW participated in the 6 month interview, and 84% of 32 MA and 88% of 8 NHW participated in the 12 month interview. No patients refused at either time point; the remainder could not be contacted. The figure shows trajectories of ADL score by ethnicity, and worsening scores among MA over time. Interest in longer-term follow-up was high (96% of 25 NHWs and 97% of 38 MAs). Caregivers of MA stroke survivors were most often children (41%) followed by spouses (36%), but were spouses (43%) followed by children (29%) for NHWs. Of 29 caregivers interviewed, 54% of MA and 57% of NHW reported being strained (CSI≥7). Caregiver strain was associated with 90-day ADL score: prevalence ratio = 1.34, 95%CI (1.01, 1.76) for 1 unit increase in ADL score. Conclusions: Our data demonstrate the feasibility of recruiting MA stroke survivors for long-term outcome assessments and suggests that MAs have worse functional outcome and greater functional declines than NHWs. The informal caregiver burden is related to functional outcome and is high in both ethnic groups.

Download Full-text

A Clinical Case Of a Patient With Anorexia Nervosa And Bizarre Behavior

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1550 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S428-S428

Author(s):

A. Fonseca ◽

A. Poças ◽

J. Melim ◽

R. Araújo

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Habits ◽

Psychiatric Service ◽

Fatal Outcome ◽

Public Health Problem ◽

Point Of View ◽

Mental Illnesses ◽

High Morbidity ◽

Bizarre Behavior

Eating disorders (EDs) are mental illnesses, defined by abnormal eating habits. EDs are chronic, severe and difficult to treat, and cause psychological, social and physical consequences. It occurs predominantly in adolescents and young adults women (around 90%), causing severely disability, major biopsychosocial losses, and high morbidity and mortality. EDs are considered by WHO as a public health problem, affecting different ages, genres, times, regions and contexts.ObjectiveCase report of a patient with Anorexia Nervosa and bizarre behavior.MethodsClinical observation in hospital.ResultsWoman with 43 years old, with a peace of 65 years, who was hospitalized in Psychiatric Service – Eating Disorders, in August 2015, because of its extreme thinness, with difficulty to walk and with severe edema of the feet, ankles and legs. At the entrance, she weighed 29 kg, after 4 days her weight reduced to 23 kg, reaching a BMI of 8.5 kg/m2. In the first week, she showed a high cognitive impairment, confusional state and detailed and ruminative speech about food. She had developed multiple techniques to hide food and to hide and take dietary supplements for weight loss. Furthermore, she had a bizarre behavior and marked social isolation, not interacting with other patients.ConclusionAlthough the low prevalence of EDs, these have a high morbidity, and are one of the psychiatric disorders that most often leads to a fatal outcome. Treatment is lengthy and cumbersome, requiring serious investments under the personal point of view, family and clinical, yet still, these patients can have a full life and quality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Twelve-year course and outcome of bulimia nervosa

Psychological Medicine ◽

10.1017/s0033291704002673 ◽

2004 ◽

Vol 34 (8) ◽

pp. 1395-1406 ◽

Cited By ~ 102

Author(s):

MANFRED M. FICHTER ◽

NORBERT QUADFLIEG

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Bulimia Nervosa ◽

General Pattern ◽

Prospective Longitudinal Study ◽

End Of Treatment ◽

Co Morbidity ◽

Prospective Longitudinal

Background. Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).Method. One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.Results. The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70·1%) showed no major DSM-IV eating disorder, 13·2% had eating disorders not otherwise specified, 10·1% had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.Conclusions. Course and outcome of BN-P was generally more favourable than for anorexia nervosa.

Download Full-text

An epidemiological study on eating disorders in two high schools in Naples

European Psychiatry ◽

10.1016/s0924-9338(97)80003-x ◽

1997 ◽

Vol 12 (7) ◽

pp. 342-344 ◽

Cited By ~ 12

Author(s):

P Cotrufo ◽

V Barretta ◽

P Monteleone

Keyword(s):

High School ◽

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

High School Girls ◽

School Girls ◽

Dsm Iv

SummaryIn this study, we investigated the prevalence of full syndrome (FS), partial syndrome (PS) and subclinical syndrome (SCS) eating disorders in a sample of 356 high school girls. We identified two cases of anorexia nervosa (0.56%), 14 of bulimia nervosa (3.94%) and one of binge eating disorder (0.28%) according to Diagnostic and Statistical Manual (DSM)-IV. Moreover, 17 girls (4.77%) were recognized as PS cases and 49 (13.7%) as SCS cases. A follow-up is now ongoing to explore the clinical evolution of partial and subclinical syndromes.

Download Full-text

Reversibility of brain tissue loss in anorexia nervosa assessed with a computerized Talairach 3-D proportional grid

Psychological Medicine ◽

10.1017/s0033291700034772 ◽

1996 ◽

Vol 26 (2) ◽

pp. 381-390 ◽

Cited By ~ 63

Author(s):

V. W. Swayze ◽

A. Andersen ◽

S. Arndt ◽

R. Rajarethinam ◽

F. Fleming ◽

...

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Repeated Measures ◽

Brain Volume ◽

Tissue Loss ◽

Control Group ◽

Total Brain Volume ◽

Total Brain ◽

Head Positioning

SynopsisWe describe the results of our follow-up magnetic resonance imaging (MRI) study of underweight patients with anorexia nervosa, using rigorous methodology to control for head position across time. All subjects first underwent an initial scan and rescan to verify that our computerized three-dimensional co-planar grid method for volume measurement was reliable and accurate, regardless of head positioning. After a period of several months, subjects had a follow-up scan to assess for changes that may have occurred following significant weight gain.Ventricular and total brain volume measurements from the initial scans were compared with the scans from an age- and sex-matched normal control group to determine whether we could replicate previous findings of ventricular enlargement compared with controls and whether brain volume is reduced compared with controls. Anorexic subjects had significantly larger ventricles when compared with normal controls but did not differ significantly in total brain volume. Using a repeated measures analysis of variance,a prioricontrasts compared the initial/rescan pair volumes with each other and the initial/rescan pair volumes with the follow-up volume. These analyses showed that ventricular and total brain volumes derived from the initial/rescan pair were nearly identical, but that at follow-up ventricular volume decreased significantly and total brain volume increased significantly after weight gain.

Download Full-text