Evidence-Based Treatment for the Eating Disorders

2010 ◽  
pp. 451-451
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

Evidence-Based Treatment for the Eating Disorders

2012 ◽  
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Evidence Base ◽  
Good Evidence ◽  
Distinct Advantage ◽  
Specialist Care ◽  
Feeding And Eating Disorders ◽  
Online Therapies ◽  
Primary Care Practitioners

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.

FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

2015 ◽  
pp. 1-2
Author(s):  
A. SINCLAIR
Keyword(s):  
Primary Care ◽  
Target Population ◽  
Population Based ◽  
Care Staff ◽  
Long Term Conditions ◽  
Primary Care Research ◽  
Wide Range ◽  
Primary Care Practitioners ◽  
Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

scholarly journals What methods are being used to create an evidence base on the use of laboratory tests to monitor long-term conditions in primary care? A scoping review

2020 ◽  
Vol 37 (6) ◽  
pp. 845-853
Author(s):  
Martha M C Elwenspoek ◽  
Lauren J Scott ◽  
Katharine Alsop ◽  
Rita Patel ◽  
Jessica C Watson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Scoping Review ◽  
Laboratory Tests ◽  
Evidence Base ◽  
Future Research ◽  
Patient Harm ◽  
Long Term Conditions ◽  
Test Ordering

Abstract Background Studies have shown unwarranted variation in test ordering among GP practices and regions, which may lead to patient harm and increased health care costs. There is currently no robust evidence base to inform guidelines on monitoring long-term conditions. Objectives To map the extent and nature of research that provides evidence on the use of laboratory tests to monitor long-term conditions in primary care, and to identify gaps in existing research. Methods We performed a scoping review—a relatively new approach for mapping research evidence across broad topics—using data abstraction forms and charting data according to a scoping framework. We searched CINAHL, EMBASE and MEDLINE to April 2019. We included studies that aimed to optimize the use of laboratory tests and determine costs, patient harm or variation related to testing in a primary care population with long-term conditions. Results Ninety-four studies were included. Forty percent aimed to describe variation in test ordering and 36% to investigate test performance. Renal function tests (35%), HbA1c (23%) and lipids (17%) were the most studied laboratory tests. Most studies applied a cohort design using routinely collected health care data (49%). We found gaps in research on strategies to optimize test use to improve patient outcomes, optimal testing intervals and patient harms caused by over-testing. Conclusions Future research needs to address these gaps in evidence. High-level evidence is missing, i.e. randomized controlled trials comparing one monitoring strategy to another or quasi-experimental designs such as interrupted time series analysis if trials are not feasible.

Somatic symptom and related disorders

2017 ◽  
Author(s):  
Alexandra Murray ◽  
Anne Toussaint ◽  
Bernd Löwe
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Somatoform Disorders ◽  
Psychological Symptoms ◽  
Diagnostic Process ◽  
Specialist Care ◽  
Optimal Care ◽  
Effective Interventions ◽  
Care Approach ◽  
Primary Care Practitioners

Somatoform disorders are common in primary care and are associated with impairment and high health care costs. The biopsychosocial approach is central to the foundations of optimal care for these patients. Potential psychosocial influences on patient suffering should be identified and discussed early in the diagnostic process which is consistent with the new emphasis on positive psychological symptoms in DSM-5. Primary care practitioners (PCPs) should use a stepped-care approach when considering treatment depending on risk profiles. While patients with lower severity can be managed by the PCP, patients with a higher risk profile may need psychotherapy or other specialist care. Psychotherapy, new generation antidepressants, and natural pharmacological products are potentially effective interventions. This chapter also describes Sofu-Net, an example of a complex intervention to help strengthen the connection and communication between PCPs and psychotherapists. An alternative collaborative care approach integrates mental health care and management into primary care.

scholarly journals Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults

2016 ◽  
Vol 176 (5) ◽  
pp. 671 ◽  
Author(s):  
Nancy L. Schoenborn ◽  
Theron L. Bowman ◽  
Danelle Cayea ◽  
Craig Evan Pollack ◽  
Scott Feeser ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Long Term Prognosis ◽  
Primary Care Practitioners

scholarly journals Impacts of COVID-19 on long-term health and health care use

2021 ◽  
Author(s):  
Katrine Skyrud ◽  
Kjetil Telle ◽  
Karin Magnusson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Use ◽  
Positive Test ◽  
Specialist Care ◽  
Positive Health ◽  
Before And After ◽  
Specialist Health Care ◽  
Respiratory Conditions

AimTo explore impacts of mild and severe COVID-19 on acute and long-term utilization of primary care, inpatient- and outpatient specialist health care.MethodsIn all persons tested for the SARS-CoV-2 in Norway March 1st to November 1st 2020 (N=1 257 831), we used a difference-in-differences design to contrast the monthly health care use before and after testing, across patients with negative test (no COVID-19) and 1) positive test, not hospitalized (mild COVID-19) and 2) positive test, hospitalized (severe COVID-19). We studied all-cause- and cause-specific health care use for digestive, circulatory, respiratory, endocrine/metabolic/nutritional, genitourinary, eye/ear, musculoskeletal, mental, skin, blood and general/unspecified conditions.ResultsMild COVID-19 impacted on primary care due to respiratory conditions at 0-3 months after having tested positive (786% increase). Severe COVID-19 impacted on visits due to respiratory-(337-3316% increase), circulatory-(166-205% increase), endocrine/metabolic/nutritional-(168-791% increase) as well as visits due to general/unspecified conditions (48-431% increase) in outpatient and inpatient specialist care 0-3 months after being tested. Severe COVID-19 also impacted on outpatient specialist care after 4-6 months, for respiratory and circulatory conditions (199-246% increase) and general/unspecified conditions (40% increase).ConclusionOur findings imply that mild COVID-19 does not persist to cause a need for health care beyond two months after having tested positive. Health care contacts increased the most in specialist care for those who had undergone severe COVID-19, both at 0-3 and at 4-6 months. This increase was due to respiratory, circulatory, endocrine/metabolic/nutritional and general/unspecified causes.

scholarly journals The Pharmacological Options in the Treatment of Eating Disorders

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
W. Milano ◽  
M. De Rosa ◽  
L. Milano ◽  
A. Riccio ◽  
B. Sanseverino ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Social Impact ◽  
Good Evidence ◽  
Obsessive Compulsive ◽  
Body Weight Reduction ◽  
Second Generation Antipsychotics ◽  
High Doses ◽  
Body Shapes ◽  
And Behavior

The eating disorders (DCA) are complex systemic diseases with high social impact, which tend to become chronic with significant medical and psychiatric comorbidities. The literature data showed that there is good evidence to suggest the use of SSRIs, particularly at high doses of fluoxetine, in the treatment of BN reducing both the crisis of binge that the phenomena compensates and reducing the episodes of binge in patients with BED in the short term. Also, the topiramate (an AED) showed a good effectiveness in reducing the frequency and magnitude of episodes of binge with body weight reduction, both in the BN that is in the therapy of BED. To date, modest data support the use of low doses of second-generation antipsychotics in an attempt to reduce the creation of polarized weight and body shapes, the obsessive component, and anxiety in patients with AN. Data in the literature on long-term drug treatment of eating disorders are still very modest. It is essential to remember that the pharmacotherapy has, however, a remarkable efficacy in treating psychiatric disorders that occur in comorbidity with eating disorders, such as mood disorders, anxiety, insomnia, and obsessive-compulsive personality disorders and behavior.

Eating disorders

2019 ◽  
pp. 313-322
Author(s):  
Agnes Ayton
Keyword(s):  
Eating Disorders ◽  
Real Life ◽  
Evidence Base ◽  
Point Of View ◽  
Hospital Treatment ◽  
Increasing Demand ◽  
The Uk ◽  
Body Mass Indexes ◽  
Physical Morbidity

There is increasing demand for inpatient treatment of severe eating disorders, both in the UK and internationally. However, hospital treatment of severe eating disorders remains controversial, mainly because of poor long-term outcomes. This chapter provides a highly relevant and clinically focused review of the complex issues involved in inpatient care of people with severe eating disorders. The main guidelines and evidence base are critically reviewed from the point of view of a real-life clinical practice dealing with people with very low body mass indexes. Evidence, or lack of it, for a range of interventions is outlined, including artificial feeding and compulsory treatment. Practical issues regarding management of weight, physical morbidity, and psychological interventions are discussed.

scholarly journals Atypical early-onset eating disorders

2014 ◽  
Vol 20 (5) ◽  
pp. 330-339
Author(s):  
Dasha Nicholls ◽  
Elizabeth Barrett ◽  
Sarah Huline-Dickens
Keyword(s):  
Eating Disorders ◽  
Children And Adolescents ◽  
Middle Childhood ◽  
Rapid Development ◽  
Evidence Base ◽  
List Type ◽  
Dsm 5 ◽  
Feeding And Eating Disorders ◽  
Low Weight ◽  
Case Vignettes

SummaryThis article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the ‘atypical’ feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5.Learning Objectives•Be able to describe the recent changes in terminology of DSM-5 for eating disorders in children and adolescents.•Be able to provide information to young people and parents on the short- and long-term medical consequences of low weight in children.•Be able to assess risk in children presenting with atypical eating disorders.

scholarly journals What is the evidence behind guideline recommendations to monitor chronic diseases in UK primary care?

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702917
Author(s):  
Martha Elwenspoek ◽  
Rita Patel ◽  
Jessica Watson ◽  
Ed Mann ◽  
Katharine Alsop ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Evidence Base ◽  
Future Research ◽  
Level Of Evidence ◽  
Long Term Conditions ◽  
Optimal Monitoring ◽  
Monitoring Strategies

BackgroundMore than half of tests ordered by GP practices are to monitor long-term conditions such as high blood pressure, diabetes, and chronic kidney disease (CKD). There is a large variation in ordered tests between GP practices, suggesting some tests may not be appropriate. Unnecessary testing should be avoided as it can generate anxiety for patients, increase workload for doctors, and increase costs for the health service.AimThe objective was to review monitoring strategies for hypertension, type 2 diabetes, and CKD patients and to investigate the evidence-base underlying these recommendations.MethodCurrent UK guidelines on the relevant diseases were reviewed. Any guidance on the use of laboratory tests for disease monitoring (not including drug monitoring recommendations), the recommended frequency of testing, as well as the level of evidence on which the guidance was based was extracted.ResultsGuidelines for the use of monitoring tests in primary care for hypertension, diabetes, and CKD are unclear and incomplete; for example, recommended frequency of testing varied between guidelines or was not specified at all. Current recommendations for monitoring chronic diseases are largely based on expert opinion; robust evidence for optimal monitoring strategies and testing intervals is lacking.ConclusionIn the absence of clear evidence, clinicians should consider which tests are likely to influence patient management and should ensure that there is a clear clinical rationale for each test that they perform. Future research should address what the optimal strategy for monitoring chronic conditions consists of, and how it can be evaluated.

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