Cognitive behaviour therapy for adolescents with eating disorders: An effective alternative to the disease-based treatments

Several clinical services offer eclectic multidisciplinary treatments with no evidence of efficacy and effectiveness for adolescents with eating disorders. These treatments are usually based on the ‘disease model’ of eating disorders. The model postulates that eating disorders are the result of a specific disease (i.e., anorexia nervosa, bulimia nervosa or other eating disorders), and patients are considered not to have control of their illness. Therefore, they need the external control of parents and/or health professionals. In this model, the patients adopt a passive role in the treatment. On the contrary, enhanced cognitive behaviour therapy (CBT-E) for adolescents is based on a ‘psychological model’ of eating disorders. Patients are helped to understand the psychological mechanisms that maintain their eating disorder and are ‘actively’ involved in the recovery process. Clinical studies showed that more than 60% of adolescent patients who complete the treatment achieve a full response at 12-month follow-up. The treatment is well accepted by young people and their parents, and its collaborative nature is well suited to ambivalent young patients who may be particularly concerned about control issues and for parents who cannot participate in all treatment sessions.

Polycystic Ovary Syndrome: It is time to change the approach in diagnosis and management

Polycystic ovary syndrome (PCOS) is a common and very distressing condition in women of reproductive age. International evidence-based guideline for the assessment and management of polycystic ovary syndrome was published in 2018, with a governance including an international advisory board from six continents. The global guideline has provided a well-rounded and all-inclusive synopsis of all aspects of PCOS. Recommendations made are clear and should help eliminate areas of conflict. The addition of large sections addressing lifestyle and emotional wellbeing puts the prevalence of eating disorders in PCOS in the spotlight and strengthens the importance of looking at the patient as a whole rather than a collection of individual symptoms and problems to solve. This commentary focuses on the evidence against many unnecessary and even harmful practices we still frequently encounter: the diagnostic criteria in teenagers, the lack of optimal ultrasound reporting, the unnecessary recommendation for non-evidence-based diets, and the harmful effects of untimely discussions disregarding women’s priorities, communication preferences, beliefs culture and mental health. Last but not least, although screening for eating disorders has been recommended by many medical societies, especially before any triggering discussion about lifestyle changes, it is still rarely done in clinical practice.

Enhanced cognitive behaviour therapy for adolescents with eating disorders: A systematic review of current status and future perspectives

This systematic review analysed published data on the effectiveness of enhanced cognitive behaviour therapy (CBT-E) for adolescents with eating disorders. Of the 28 papers retrieved, eight (6 case series, 1 prospective cohort study, and 1 non-randomized effectiveness trial) met the inclusion criteria and revealed the following five findings. First, outpatient CBT-E is well accepted by adolescent patients with anorexia nervosa; it is completed by about two-thirds of participants, and produces improvements in eating-disorder and general psychopathology. Remission from anorexia nervosa is achieved by about 50% of patients at 12-month follow-up. Second, outpatient CBT-E seems more effective for adolescents than adults. Third, inpatient CBT-E for adolescents with anorexia nervosa seems particularly effective — about 80% of patients achieve normal weight by 12-month follow-up. Fourth, CBT-E also seems promising for adolescents who are not underweight. Fifth, CBT-E appears to yield similar outcomes to FBT in terms of weight regain and eating-disorder and general psychopathology improvements at 6- and 12-month follow-up. The fourth and fifth findings derive from a single study and require confirmation. In conclusion, CBT-E is a viable and promising treatment for adolescents with eating disorders.

Evaluating renal function and defining protein requirements in patients affected by anorexia nervosa: a case report

Anorexia Nervosa (AN) is associated with high somatic comorbidities. Among them, impaired renal function is frequently overlooked by physicians. Since a high rate of individuals affected by AN may become chronically ill, assessing renal function is crucial to prevent further deterioration of the kidney-related condition. An accurate evaluation of GFR is also critical to prevent drug toxicity and to provide appropriate protein requirements during nutritional rehabilitation. Furthermore, optimizing protein intake is key to a positive protein balance and to promote muscle anabolism. Literature is scarce and no univocal guidelines exists to define how to estimate GFR in those patients. Equations relied on serum creatinine may not be accurate to estimate GFR in AN patients, especially in case of cachexia. We therefore describe the case of a women with a 22 year-history of anorexia nervosa, in which eGFR based on serum creatinine was falsely normal and impaired renal function was revealed by unusual electrolytes disturbances. In conclusion, we think clinicians should consider collecting 24-hour urine and calculate creatinine clearance to correctly assess renal function. Dedicated guidelines are needed to define the optimal daily protein intake in malnourished patients with AN and CKD during weight gain and weight maintenance phases.

Disturbo da binge-eating - Un update

Binge-eating disorder (BED) is characterized by the presence of recurrent binge-eating episodes not followed by the recurrent use of compensatory behaviors, occurring at least once a week for three months, and associated with marked distress. According to the most recent data, BED has a lifetime prevalence of 0.85% (men 0.42% and women 1.25%). The disorder, although it is also present in normal-weight individuals, is more frequent in those with obesity. BED often coexists with specific mental disorders (e.g., depressive disorders, anxiety disorders, substance use disorders, or impulse control disorders) and with general medical conditions (e.g., cardiometabolic diseases). Psychological treatments, such as cognitive behaviour therapy (CBT), produce remission of binge-eating episodes in about 50-55% of patients, but have a limited effect on weight loss when BED is associated with obesity. Pharmacological treatments for anxiety and depression have limited effects on the symptoms of BED, while some drugs that have shown promising results, such as lisdexamfetamine and dasotraline, are often burdened with important side effects and are not available in Italy. The need to develop a treatment able to determine both a modest, but clinically significant, weight loss and a simultaneous remission of binge-eating episodes and associated psychopathology, has led to design a new treatment, under evaluation, called “CBT-BO”, which integrates strategies and procedures of the CBT-E for eating disorders and CBT for obesity.