scholarly journals Early weight gain trajectories in first episode anorexia: predictors of outcome for emerging adults in outpatient treatment

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
A. Austin ◽  
M. Flynn ◽  
K. L. Richards ◽  
H. Sharpe ◽  
K. L. Allen ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Emerging Adults ◽  
Clinical Outcomes ◽  
Outpatient Treatment ◽  
Early Response ◽  
First Episode ◽  
Treatment Start ◽  
Early Weight Gain

Abstract Background Early response to treatment has been shown to be a predictor of later clinical outcomes in eating disorders (EDs). Specifically, early weight gain trajectories in anorexia nervosa (AN) have been shown to predict higher rates of later remission in inpatient treatment. However, no study has, as of yet, examined this phenomenon within outpatient treatment of first episode cases of AN or in emerging adults. Methods One hundred seven patients with AN, all between the ages of 16 and 25 and with an illness duration of < 3 years, received treatment via the first episode rapid early intervention in eating disorders (FREED) service pathway. Weight was recorded routinely across early treatment sessions and recovery outcomes (BMI > 18.5 kg/m2 and eating psychopathology) were assessed up to 1 year later. Early weight gain across the first 12 treatment sessions was investigated using latent growth mixture modelling to determine distinct classes of change. Follow-up clinical outcomes and remission rates were compared between classes, and individual and clinical characteristics at baseline (treatment start) were tested as potential predictors. Results Four classes of early treatment trajectory were identified. Three of these classes (n = 95), though differing in their early change trajectories, showed substantial improvement in clinical outcomes at final follow-up. One smaller class (n = 12), characterised by a ‘higher’ start BMI (> 17) and no early weight gain, showed negligible improvement 1 year later. Of the three treatment responding groups, levels of purging, depression, and patient reported carer expressed emotion (in the form of high expectations and low tolerance of the patient) determined class membership, although these findings were not significant after correcting for multiple testing. A higher BMI at treatment start was not sufficient to predict optimal clinical outcomes. Conclusion First episode cases of AN treated via FREED fit into four distinct early response trajectory classes. These may represent subtypes of first episode AN patients. Three of these four trajectories included patients with substantial improvements 1 year later. For those in the non-response trajectory class, treatment adjustments or augmentations could be considered earlier, i.e., at treatment session 12.

scholarly journals “I’m truly free from my eating disorder”: Emerging adults’ experiences of FREED, an early intervention service model and care pathway for eating disorders

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rachel Potterton ◽  
Amelia Austin ◽  
Michaela Flynn ◽  
Karina Allen ◽  
Vanessa Lawrence ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Early Intervention ◽  
Emerging Adults ◽  
Care Pathway ◽  
Support Network ◽  
First Episode ◽  
Service Model ◽  
Access To Treatment ◽  
Rapid Access

Abstract Background Eating disorders (EDs) typically start during adolescence or emerging adulthood, periods of intense biopsychosocial development. FREED (First Episode Rapid Early Intervention for EDs) is a service model and care pathway providing rapid access to developmentally-informed care for emerging adults with EDs. FREED is associated with reduced duration of untreated eating disorder and improved clinical outcomes, but patients’ experiences of treatment have yet to be assessed. Objective This study aimed to assess emerging adults’ experiences of receiving treatment through FREED. Method This study triangulated qualitative data on participants’ experiences of FREED treatment from questionnaires and semi-structured interviews. Participants were 106 emerging adults (aged 16–25; illness duration < 3 yrs) (questionnaire only = 92; interview only = 6; both = 8). Data were analysed thematically. Results Most participants reported psychological and behavioural changes over the course of treatment (e.g. reduction in symptoms; increased acceptance and understanding of difficulties). Participants identified five beneficial characteristics of FREED treatment: i) rapid access to treatment; ii) knowledgeable and concerned clinicians; iii) focusing on life beyond the eating disorder; iv) building a support network; v) becoming your own therapist. Conclusion This study provides further supports for the implementation of early intervention and developmentally-informed care for EDs. Future service model development should include efforts to increase early help-seeking.

The Impact of Smoking on Clinical Outcomes After First Episode Psychosis: Longer-Term Outcome Findings From the EPPIC 800 Follow-Up Study

2010 ◽  
Vol 6 (3-4) ◽  
pp. 212-234 ◽  
Author(s):  
Michael Berk ◽  
Lisa P. Henry ◽  
Kathryn S. Elkins ◽  
Susy M. Harrigan ◽  
Meredith G. Harris ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
First Episode Psychosis ◽  
First Episode ◽  
Term Outcome ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
The Impact

scholarly journals Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Katie L. Richards ◽  
Michaela Flynn ◽  
Amelia Austin ◽  
Katie Lang ◽  
Karina L. Allen ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Early Intervention ◽  
Emerging Adults ◽  
Care Pathway ◽  
Implementation Fidelity ◽  
Wait Time ◽  
First Episode ◽  
Service Model ◽  
Patient Journey ◽  
Care Package

Background The First Episode Rapid Early Intervention for Eating Disorders (FREED) service model is associated with significant reductions in wait times and improved clinical outcomes for emerging adults with recent-onset eating disorders. An understanding of how FREED is implemented is a necessary precondition to enable an attribution of these findings to key components of the model, namely the wait-time targets and care package. Aims This study evaluated fidelity to the FREED service model during the multicentre FREED-Up study. Method Participants were 259 emerging adults (aged 16–25 years) with an eating disorder of <3 years duration, offered treatment through the FREED care pathway. Patient journey records documented patient care from screening to end of treatment. Adherence to wait-time targets (engagement call within 48 h, assessment within 2 weeks, treatment within 4 weeks) and care package, and differences in adherence across diagnosis and treatment group were examined. Results There were significant increases (16–40%) in adherence to the wait-time targets following the introduction of FREED, irrespective of diagnosis. Receiving FREED under optimal conditions also increased adherence to the targets. Care package use differed by component and diagnosis. The most used care package activities were psychoeducation and dietary change. Attention to transitions was less well used. Conclusions This study provides an indication of adherence levels to key components of the FREED model. These adherence rates can tentatively be considered as clinically meaningful thresholds. Results highlight aspects of the model and its implementation that warrant future examination.

scholarly journals Early weight gain after stopping smoking: a predictor of overall large weight gain? A single-site retrospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e023987 ◽  
Author(s):  
Alexandra Pankova ◽  
Eva Kralikova ◽  
Kamila Zvolska ◽  
Lenka Stepankova ◽  
Milan Blaha ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Weight Gain ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Receiver Operating Curve ◽  
Large Weight ◽  
Early Weight Gain ◽  
The Mean

ObjectivesMost people gain weight on stopping smoking but the extent of weight gain varies greatly. Interventions aimed at all quitters to prevent weight gain on cessation have proven unpopular but targeting people who have gained excess weight immediately after quitting may improve uptake and cost-effectiveness. We examined whether early large postcessation weight gain predicts overall large weight gain.DesignRetrospective cohort study.SettingPrimary care setting—smoking cessation centre in Prague, Czech Republic.ParticipantsOut of 3537 patients treated between 2005 and 2013, 1050 were continuous abstainers (verified by carbon monoxide measurement) at 1-year follow-up and formed the cohort of the current report. 48.7% were women (n=511) with the mean age of 46 (±14.4) years.MethodsIn this retrospective cohort study, all patients underwent usual tobacco dependence treatment using evidence-based methods. Weight was measured prior to smoking cessation and at each visit after quitting.ResultsThe mean weight gain in the first month (n=763) was 0.79% (±2.03%), in the second month (n=646) was 1.49% (±2.58%), for the third month (n=566) 2.33% (±3.44%) and 4.1% (±5.31%) after 1-year follow-up (n=1050). The regression coefficient per 1% rise in the first 3 months was +0.13% (95% CI −0.04% to 0.30%). A receiver operating curve analysis showed that patients gaining more than 0.98% of their baseline weight during first 3 months had a sensitivity of 66% and specificity of 44% for gaining 7% or more weight by 12 months. In addition, lower body mass index and an increase in appetite at 3 months after quitting were associated with greater weight gain, while using nicotine replacement therapy was associated with less weight gain at 1-year follow-up.ConclusionsPeople who stop smoking and gain a larger amount of weight early after quitting are not more likely to gain excessively at 1 year.

scholarly journals S115. EVALUATION OF THE CLINICAL UTILITY OF SYMPTOM DIMENSIONS ON LONG-TERM CLINICAL AND FUNCTIONAL OUTCOMES IN FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S78-S78
Author(s):  
Ege Bor ◽  
Diego Quattrone ◽  
Victoria Rodriguez ◽  
Luis Alameda ◽  
Sinan Guloksuz ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Utility ◽  
Negative Symptoms ◽  
First Episode ◽  
Global Functioning ◽  
Symptom Dimensions ◽  
Episode Psychosis ◽  
Over Time

Abstract Background Current clinical utility of diagnostic categories in patients with psychosis is in debate. Alternatively, symptom-based dimensional approaches are suggested, but research on their utility and longitudinal stability is at its early phases, showing lack of consistencies. The aims of this prospective study are: 1) to test the stability of structure of symptom dimensions in first episode psychosis patients; 2) to explore the utility of symptom dimensions in predicting clinical and functional outcomes. Methods This study included a total of 208 with first episode of psychosis-spectrum disorders aged 18–65 years who presented to psychiatric services in South London, recruited as part of the Genetics and Psychosis Outcome (GAP) case-control study and EU-GEI multicentre case-control study. A subsample of 114 patients were traced after a mean of 6.5 years. Psychopathology was assessed at baseline and at follow-up using OPCRIT and tested with bifactor model, encompassing one general psychosis dimension and five specific symptom dimensions (positive, negative, disorganisation, mania, and depression). Follow up measures on functional outcome (assessed with GAF scale) and clinical outcomes (number and total length of hospitalisations) were derived from clinical records. Predictor role of baseline symptom dimensions was tested by multiple linear regression to predict global functioning; and by negative binomial regression for length of hospitalisation and number of hospital admissions. Results Factor loadings of disorganisation dimension were most likely to change longitudinally while loadings of positive dimension were most stable. Regarding dimension stability over time, all positive, disorganised and depressive symptoms significantly improved over time while manic and negative symptoms did not significantly differ. In terms of prediction of outcome, baseline manic symptoms were associated with reduced risk of hospitalisation (adj OR 1.56; 95% CI 1.01–2.38), reduced length of hospitalisation (adj IRR= 0.73; 95% CI 0.56–0.95) and better global functioning (β=5.21; 95% CI 2.46–7.95) at follow up. Similarly, depressive symptoms were associated with reduced length of hospitalisation (adj IRR= 0.77; CI 0.61–0.97). On the other hand, baseline positive symptoms were associated with increased risk of hospitalisation (adj OR 1.93; 95% CI 1.25–2.96). No other significant associations were found between the rest of symptom dimensions and outcomes. Discussion This study provides new evidence on the longitudinal stability of bifactor model of psychosis and, shows that all except manic and negative symptoms significantly improved over time. Whereas affective symptoms (including mania and depression) were associated with good prognosis, positive symptoms seem to predict poor clinical outcomes. The particular and different influence of affective and psychotic symptoms on long-term functional and clinical outcomes may have therapeutic implications and support the potential clinical utility of incorporating symptom-based approach in further outcome research.

scholarly journals The First Episode Rapid Early Intervention for Eating Disorders ‐ Upscaled study: Clinical outcomes

2021 ◽  
Author(s):  
Amelia Austin ◽  
Michaela Flynn ◽  
James Shearer ◽  
Mike Long ◽  
Karina Allen ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Early Intervention ◽  
Clinical Outcomes ◽  
First Episode

Antioxidant enzymes and weight gain in drug-naive first episode schizophrenia patients treated with risperidone for 12 weeks: a prospective longitudinal study

2021 ◽  
Vol 19 ◽  
Author(s):  
Haixia Liu ◽  
Rui Yu ◽  
Yanan Gao ◽  
Xirong Li ◽  
Xiaoni Guan ◽  
...  
Keyword(s):  
Antioxidant Enzymes ◽  
Weight Gain ◽  
Antioxidant Enzyme ◽  
Enzyme Activities ◽  
First Episode ◽  
Antioxidant Enzyme Activities ◽  
Healthy Controls ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

: Oxidative stress plays an important role in weight gain induced by antipsychotics in schizophrenia (SCZ). However, little is known about how antioxidant enzymes are involved in weight gain caused by risperidone monotherapy in antipsychotics-naïve first-episode (ANFE) patients with SCZ. Therefore, the main purpose of this study was to investigate the effects of risperidone on several antioxidant enzymes in patients with ANFE SCZ and the relationship between weight gain and changes in antioxidant enzyme activities. The activities of plasma superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), as well as the levels of malondialdehyde (MDA) were measured in 225 ANFE patients and 125 healthy controls. Patients were treated with risperidone monotherapy for 12 weeks. Clinical symptoms, antioxidant enzyme activities and MDA levels were measured at baseline and during follow-up. Compared with healthy controls, the patients showed higher activities of SOD and CAT, but lower MDA levels and GPx activity. At baseline, the CAT activity was associated with bodyweight or BMI. Further, based on a 7% weight increase from baseline to follow-up, we found 75 patients in the weight gain (WG) group and 150 patients in the non-WG group. Comparison between WG group and non-WG group at baseline and during the 12-week follow-up, it was found that after treatment, the SOD activity in the WG group increased while the MDA level decreased in non-WG group. Moreover, baseline SOD and GPx activities were predictors of weight gain at 12-week follow-up. These results suggest that the antioxidant defense system may have predictive value for the weight gain of ANFE SCZ patients after risperidone treatment.

Early insulin resistance predicts weight gain and waist circumference increase in first-episode psychosis – A one year follow-up study

2015 ◽  
Vol 169 (1-3) ◽  
pp. 458-463 ◽  
Author(s):  
Jaakko Keinänen ◽  
Outi Mantere ◽  
Tuula Kieseppä ◽  
Teemu Mäntylä ◽  
Minna Torniainen ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Weight Gain ◽  
Waist Circumference ◽  
First Episode Psychosis ◽  
First Episode ◽  
Follow Up Study ◽  
Episode Psychosis ◽  
One Year

scholarly journals Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3946
Author(s):  
Julie A. Mennella ◽  
Alissa D. Smethers ◽  
Jessica E. Decker ◽  
Michelle T. Delahanty ◽  
Virginia A. Stallings ◽  
...  
Keyword(s):  
Weight Gain ◽  
Infant Formula ◽  
Diet Quality ◽  
Weight Status ◽  
Dietary Habits ◽  
Interactive Effects ◽  
Snack Food ◽  
Early Weight Gain ◽  
Formula Group

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

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