Title: Treatment of Anorexia nervosa: Translating experimental neuroscience into clinical practice.
Funder: Department of Health (England)

Abstract: Aims and Objectives We will address key health service questions relevant to the treatment and management of eating disorders (ED). The aims and objectives are to: Produce, validate and disseminate improved treatments for people with anorexia nervosa (AN), that target disease-maintaining factors and are matched to symptoms, personality and neuropsychological profile. Evaluate and disseminate interventions for carers of people with AN. Study service utilisation and cost of illness in ED. Background AN is a severe illness with the highest mortality of any psychiatric disorder. Onset is typically in adolescence. Starvation at this time has the potential for permanently altering brain function. Families carry much of the burden: parents are often desperate for help, whereas the person with AN may find it hard to be aware of the problem. Early family-based treatment delivered by experts has excellent outcomes, but is not widely available. Once AN is well established it is harder to treat and outcomes are poor. People with AN have characteristic personality traits: they are often obsessional, perfectionist, anxious and avoidant of emotions. These traits moderate outcome. Parents may inadvertently contribute to maintaining the disorder, e.g. by expressing distress through criticism or hostility, resulting in battles about food and weight. Research Plan Seven independent, but integrated work packages with common assessment tools are proposed. These aim to inform optimal disease management for people with AN at all stages of illness. We have packages designed to improve early pathways of care from detection to early intervention as well as those focusing on the needs of those with the most severe form of the illness and for special groups, e.g. mothers with ED and women with reproductive problems Several packages focus on producing and testing targeted, modularized assessments and treatments of AN that are matched to the symptoms, personality and neuropsychological profile of people with the illness. This will be possible by applying our knowledge of factors involved in the development and maintenance of AN. We will test interventions empowering carers to help manage the illness. We will evaluate physical and endocrine changes associated with illness and recovery. Finally, in addition to cost-of-illness, cost modelling and cost-effectiveness studies we will explore care pathways and patterns of service use. Research Team We have a track-record in treatment research, including randomised controlled trials and aetiological studies. We have a long-standing collaboration with the Eating Disorders Association (EDA), our partner in this programme. Under the auspices of the Mental Health Reseach Network, we have research collaborations with many UK eating disorder units who we will involve in this work. Our work has attracted 6 R&D grants and has led to the development of disseminable outputs such as web-programmes, books and DVDs. Research Environment We have the clinical and research expertise and infrastructure to conduct this programme. The ED Unit of the South London and Maudsley NHS Trust is a Centre of Clinical and Research Excellence providing inpatient, residential, day care and outpatient services for a large local catchment area. The Inst. of Psychiatry is the UK’s top psychiatric research centre. The EDA is the UK’s leading Charity for people with ED and their carers. It runs a range of information and support services (e.g. help lines and self-help groups). Anticipated outputs, outcomes and impact of this research Outputs: Publication of scientific papers and manuals, DVDs and on-line materials for patients, carers, and health professionals. Outcomes: Availability of effective reproducible standardised disseminable treatment modules for AN and related training materials for use with people at different stages of AN and in different settings. Impact: Improved clinical outcomes in adults with AN with reduced chronicity, disability and relapse, reduced carer distress and NHS costs. Public Involvement The work will be carried out in partnership with the EDA. Other patient and carer representatives will also be involved. Ethical Implications We do not foresee any major ethical problems We will set up 2 independent monitoring committees: a Trial Steering Group and a Data Monitoring and Ethics Committee. Justification for the resources We require £1,998,286 to conduct this programme. This is £1,311030 for research personnel and £387,256 for running the studies and for developing and supporting the web-based intervention. The NHS support costs stated are the estimated additional patient-related costs associated with the research proposed in this programme. These have been calculated on the basis of a review of the clinical services hosting the proposed research and the expected impact of the research activity on these services, the main cost driver being NHS staff time.?


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH