Impact of hospitalisation on the outcome of adolescent anorexia nervosa. A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost-effectiveness and patient acceptability - the TOuCAN trial. Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. Manualized family-based treatment for anorexia nervosa: a case series. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. Family Therapy versus Individual Therapy for Adolescent Females with Anorexia Nervosa A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK Clinical effectiveness of treatments for anorexia nervosa in adolescents: randomised controlled trial. Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): Comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: A randomize A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. The impact of social skills training within an established in-patient treatment programme for anorexia nervosa. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial A practical comparison of two types of family intervention: an exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for adults with anorexia nervosa. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. A randomised controlled trial of three psychological treatments for anorexia nervosa. Does internet-based prevention reduce the risk of relapse for anorexia nervosa? Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents. Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa.
BACKGROUND Owing to the lack of controlled trials of treatment setting in adolescent anorexia nervosa , the benefits and costs of in-patient treatment are not established . AIMS To clarify the relationship between a range of presenting features , treatment received and medium- to long-term outcome in adolescent anorexia nervosa . METHOD A range of presenting variables were rated for 75 cases of DSM-III-R anorexia nervosa at presentation to an adolescent service , including the Morgan-Russell Global Assessment Score . Cases were followed up at 2 - 7 years and outcome rated according to reliable methods . Setting of treatment received was also recorded . RESULTS Two out of 75 cases had died by the time of follow-up . Adequate data for 72 enabled an outcome category to be assigned . The 21 who had received inpatient treatment had a significantly worse outcome than the 51 never admitted to hospital . Multivariate analysis suggests admission to be the major predictor of poor outcome . CONCLUSIONS The benefits and costs of admission to hospital require further investigation , ideally in a r and omised-controlled trial . The negative consequences of in-patient treatment are neglected in research OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of inpatient compared with outpatient treatment and general ( routine ) treatment in Child and Adolescent Mental Health Services ( CAMHS ) against specialist treatment for young people with anorexia nervosa . In addition , to determine young people 's and their carers ' satisfaction with these treatments . DESIGN A population -based , pragmatic r and omised controlled trial ( RCT ) was carried out on young people age 12 to 18 presenting to community CAMHS with anorexia nervosa . SETTING Thirty-five English CAMHS in the north-west of Engl and co-ordinated through specialist centres in Manchester and Liverpool . PARTICIPANTS Two hundred and fifteen young people ( 199 female ) were identified , of whom 167 ( mean age 14 years 11 months ) were r and omised and 48 were followed up as a preference group . INTERVENTIONS R and omised patients were allocated to either inpatient treatment in one of four units with considerable experience in the treatment of anorexia nervosa , a specialist outpatient programme delivered in one of two centres , or treatment as usual in general community CAMHS . The outpatient programmes spanned 6 months of treatment . The length of inpatient treatment was determined on a case-by-case basis on clinical need with outpatient follow-up to a minimum of 6 months . MAIN OUTCOME MEASURES Follow-up assessment s were carried out at 1 , 2 and 5 years . The primary outcome measure was the Morgan-Russell Average Outcome Scale ( MRAOS ) and associated categorical outcomes . Secondary outcome measures included physical measures of weight , height , body mass index ( BMI ) and % weight for height . Research ratings included the Health of the National Outcome Scale for Children and Adolescents ( HoNOSCA ) . Self report measures comprised the user version of HoNOSCA ( HoNOSCA-SR ) , the Eating Disorder Inventory 2 ( EDI-2 ) , the Family Assessment Device ( FAD ) and the recent Mood and Feelings Question naire ( MFQ ) . Information on re source use was collected in interview at 1 , 2 and 5 years using the Child and Adolescent Service Use Schedule ( CA-SUS ) . Satisfaction was measured quantitatively using a question naire design ed for the study and qualitative ( free ) responses on it . The question naire data were supplemented by qualitative analysis of user and carer focus groups . RESULTS Of the 167 patients r and omised , 65 % adhered to the allocated treatment . Adherence was lower for inpatient treatment ( 49 % ) than for general CAMHS ( 71 % ) or specialist outpatient treatment ( 77 % ) ( p = 0.013 ) . Every subject was traced at both 1 and 2 years , with the main outcome measure completed ( through contact with the subject , family members or clinicians ) , by 94 % at 1 year , 93 % at 2 years , but only 47 % at 5 years . A vali date d outcome category was assigned for 98 % at 1 year , 96 % at 2 years and 60 % at 5 years . There was significant improvement in all groups at each time point , with the number achieving a good outcome being 19 % at 1 year , 33 % at 2 years and 64 % ( of those followed up ) at 5 years . Analysis demonstrated no difference in treatment effectiveness of r and omisation to inpatient compared with outpatient treatment , or , specialist over generalist treatment at any time point , when baseline characteristics were taken into account . Generalist CAMHS treatment was slightly more expensive over the first 2 years of the study , largely because greater numbers were subsequently admitted to hospital after the initial treatment phase . The specialist outpatient programme was the dominant treatment in terms of incremental cost-effectiveness . Specialist treatments had a higher probability of being more cost-effective than generalist treatments and outpatient treatment had a higher probability of being more cost-effective than inpatient care .  Parental satisfaction with treatment was generally good , though better with specialist than generalist treatment .  Young people  's satisfaction was much more mixed , but again better with specialist treatment , including inpatient care . CONCLUSION Poor adherence to r and omisation ( despite initial consent to it ) , limits the assessment of the treatment effect of inpatient care . However , this study provides little support for lengthy inpatient psychiatric treatment on clinical or health economic grounds . These findings are broadly consistent with existing guidelines on the treatment of anorexia nervosa , which suggest that outpatient treatments should be offered to the majority , with inpatient treatment offered in rare cases , though our findings lend little support to a stepped-care approach in which inpatient care is offered to outpatient non-responders . Outpatient care , supported by brief ( medical ) inpatient management for correction of acute complications may be a preferable approach . The health economic analysis and user views both support NICE guidelines , which suggest that anorexia nervosa should be managed in specialist services that have experience and expertise in its management . Comprehensive general CAMHS might , however , be well placed to manage milder cases . Further research should focus on the specific components of outpatient psychological therapies . Although family-based treatments are well established , trials have not established their effectiveness compared with good- quality individual psychological therapies and the combination of individual and family approaches is untested . Further research is needed to establish which patients ( if any ) might respond to inpatient psychiatric treatment when unresponsive to outpatient care , the positive and negative components of it and the optimum length of stay . TRIAL REGISTRATION NRR number ( National Research Register ) N0484056615 ; Current Controlled Trials IS RCT N39345394 BACKGROUND Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor . Novel treatment approaches are urgently needed . AIMS To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa ( Maudsley Model of Anorexia Nervosa Treatment for Adults , MANTRA ) compared with specialist supportive clinical management ( SSCM ) in a r and omised controlled trial . METHOD Seventy-two adult out- patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK . Participants were r and omly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need ( trial registration : IS RCT N62920529 ) . The primary outcomes were body mass index , weight and global score on the Eating Disorders Examination at end of treatment ( 6 months ) and follow-up ( 12 months ) . Secondary outcomes included : depression , anxiety and clinical impairment ; neuropsychological outcomes ; recovery rates ; and additional service utilisation . RESULTS At baseline , patients r and omised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM ( 3/34 v. 10/36 ; P<0.05 ) . Patients in both treatments improved significantly in terms of eating disorder and other outcomes , with no differences between groups . Strictly defined recovery rates were low . However , MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM ( 7/34 v. 0/37 ; P = 0.004 ) . CONCLUSIONS Adults with anorexia nervosa are a difficult to treat group . The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM . This study confirms SSCM as a useful treatment for out- patients with anorexia nervosa . The novel treatment , MANTRA , design ed for this patient group may need adaptations to fully exploit its potential BACKGROUND There is growing evidence that family therapy is an effective treatment for adolescent anorexia nervosa . This study aim ed to ascertain the long-term impact of two forms of outpatient family intervention previously evaluated in a r and omised controlled trial ( RCT ) . METHOD A five-year follow-up was conducted on a cohort of 40 patients who had received either ' conjoint family therapy ' ( CFT ) or ' separated family therapy ' ( SFT ) .  All patients were traced and 38 agreed to be reassessed ( 29 interviewed in person , 3 completed telephone interviews , 6 completed question naires and /or agreed for parents/GP to be interviewed ) . RESULTS Overall there was little to distinguish the two treatments at 5 years , with more than 75 % of subjects having no eating disorder symptoms . There were no deaths in the cohort and only 8 % of those who had achieved a healthy weight by the end of treatment reported any kind of relapse . Three patients developed bulimic symptoms but only one to a degree warranting a diagnosis of bulimia nervosa . The one difference between the treatments was in patients from families with raised levels of maternal criticism . This group of patients had done less well at the end of treatment if they had been offered conjoint family meetings . At follow-up this difference was still evident , as shown in the relative lack of weight gain since the end of outpatient treatment . CONCLUSIONS This study confirms the efficacy of family therapy for adolescent anorexia nervosa , showing that those who respond well to outpatient family intervention generally stay well . The study provides further support for avoiding the use of conjoint family meetings at least early on in treatment when raised levels of parental criticism are evident OBJECTIVE The purpose of this study was to describe a case series of children and adolescents ( mean age = 14.5 years , SD = 2.3 ; range 9 - 18 ) with anorexia nervosa who received manualized family-based treatment for their eating disorder . METHOD Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual status . RESULTS After an average of 17 treatment sessions , patients were significantly improved on primary measures of outcome ( body mass index and percentage of ideal body weight ) . Defining outcome categorically ( Morgan-Russell outcome criteria ) , 56 % ( n = 25 ) had a good outcome ( > 85 % ideal body weight and menses ) , 33 % ( n = 15 ) an intermediate outcome ( > 85 % IBW and menses intermittent ) , and 11 % ( n = 5 ) responded poorly ( < 85 % ideal body weight and no menses ) . CONCLUSIONS Findings provide preliminary support for the feasibility of an outpatient approach with active parental involvement in the treatment of children and adolescents with anorexia nervosa . However , r and omized , controlled studies are needed to establish the relative efficacy of this family-based treatment approach BACKGROUND This study aims to assess changes in core eating disorder psychopathology ( Eating Attitudes Test , EAT ; Eating Disorders Inventory-2 , EDI-2 ) , depression ( Hamilton Rating Scale , HRSD ; Beck Depression Inventory , BDI ) and general psychopathology ( MMPI-2 ) after inpatient treatment and one-year follow-up among patients diagnosed with anorexia . METHODS Thirty-two patients were treated for anorexia nervosa on an inpatient unit , and were assessed before and after treatment . The inpatient milieu was design ed to use cognitive therapy as the primary therapeutic intervention , along with weight restoration . RESULTS At discharge , all patients displayed significant change in core eating disorder psychopathology in their depressive symptoms , as well as in general aspects of psychopathology . At one-year follow-up , changes in some areas of core eating disorder psychopathology and depressive symptoms continued to be significantly different than from admissions . CONCLUSIONS The combination of CBT and weight restoration can significantly reduce eating disorder symptoms , depression , and general psychopathology during hospitalization , with some sustained benefit over a one year period . Future research is needed to identify the effect of CBT on anorexia nervosa during a wide variety of treatment setting s. Also , research must focus on the influence of outpatient treatment in the outcome of anorexia nervosa BACKGROUND Psychotherapy is the treatment of choice for patients with anorexia nervosa , although evidence of efficacy is weak . The Anorexia Nervosa Treatment of Out Patients ( ANTOP ) study aim ed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa -- focal psychodynamic therapy and enhanced cognitive behaviour therapy -- versus optimised treatment as usual . METHODS The ANTOP study is a multicentre , r and omised controlled efficacy trial in adults with anorexia nervosa . We recruited patients from ten university hospitals in Germany . Participants were r and omly allocated to 10 months of treatment with either focal psychodynamic therapy , enhanced cognitive behaviour therapy , or optimised treatment as usual ( including outpatient psychotherapy and structured care from a family doctor ) . The primary outcome was weight gain , measured as increased body-mass index ( BMI ) at the end of treatment . A key secondary outcome was rate of recovery ( based on a combination of weight gain and eating disorder-specific psychopathology ) . Analysis was by intention to treat . This trial is registered at http://is rct n.org , number IS RCT N72809357 . FINDINGS Of 727 adults screened for inclusion , 242 underwent r and omisation : 80 to focal psychodynamic therapy , 80 to enhanced cognitive behaviour therapy , and 82 to optimised treatment as usual . At the end of treatment , 54 patients ( 22 % ) were lost to follow-up , and at 12-month follow-up a total of 73 ( 30 % ) had dropped out . At the end of treatment , BMI had increased in all study groups ( focal psychodynamic therapy 0·73 kg/m(2 ) , enhanced cognitive behaviour therapy 0·93 kg/m(2 ) , optimised treatment as usual 0·69 kg/m(2 ) ) ; no differences were noted between groups ( mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45 , 95 % CI -0·96 to 0·07 ; focal psychodynamic therapy vs optimised treatment as usual -0·14 , -0·68 to 0·39 ; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30 , -0·22 to 0·83 ) . At 12-month follow-up , the mean gain in BMI had risen further ( 1·64 kg/m(2 ) , 1·30 kg/m(2 ) , and 1·22 kg/m(2 ) , respectively ) , but no differences between groups were recorded ( 0·10 , -0·56 to 0·76 ; 0·25 , -0·45 to 0·95 ; 0·15 , -0·54 to 0·83 , respectively ) . No serious adverse events attributable to weight loss or trial participation were recorded . INTERPRETATION Optimised treatment as usual , combining psychotherapy and structured care from a family doctor , should be regarded as solid baseline treatment for adult out patients with anorexia nervosa .  Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up , and enhanced cognitive behaviour therapy  was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology . Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches . FUNDING German Federal Ministry of Education and Research ( Bundesministerium für Bildung und Forschung , BMBF ) , German Eating Disorders Diagnostic and Treatment Network ( EDNET ) IMPORTANCE Anorexia nervosa ( AN ) is a serious disorder with high rates of morbidity and mortality . Family-based treatment ( FBT ) is an evidence -based therapy for adolescent AN , but less than half of those who receive this approach recover . Hence , it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence -based treatment . OBJECTIVE To compare FBT with systemic family therapy ( SyFT ) for the treatment of adolescent-onset AN . DESIGN , SETTING , AND PARTICIPANTS Research in Anorexia Nervosa ( RIAN ) is a 2-group  ( FBT and SyFT ) r and omized trial conducted between September 2005 and April 2012 . Interviewers were blinded to the treatment condition . A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened . Of these , 262 adolescents did not meet the inclusion criteria and 138 declined to participate ; hence , 164 adolescents ( aged 12 - 18 years ) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , AN ( except for amenorrhea ) were enrolled . Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred . INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months . Family-based therapy focuses on the facilitation of weight gain , whereas SyFT addresses general family processes . MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight ( IBW ) and remission ( ≥95 % of IBW ) . The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment ( EOT ) . RESULTS There were no statistically significant differences between treatment groups for the primary outcome , for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up . Remission rates  included FBT , 33.1 % at the EOT and 40.7 % at follow-up and SyFT , 25.3 % and 39.0 % , respectively . Family-based therapy led to significantly faster weight gain early in treatment , significantly fewer days in the hospital , and lower treatment costs per patient in remission at the EOT ( FBT , $ 8963 ; SyFT , $ 18 005 ) . An exploratory moderator analysis found that SyFT led to greater weight gain  than did FBT for participants with more severe obsessive-compulsive symptoms . CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT . Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT . TRIAL REGISTRATION clinical trials.gov Identifier NCT00610753 Behavioral family systems therapy ( BFST ) was compared with ego-oriented individual therapy ( EOIT ) in a controlled , r and om-assignment investigation involving 22 young adolescents with anorexia nervosa . Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen . BFST emphasized parental control over eating and weight gain , coupled with cognitive restructuring and problem-solving communication training . EOIT emphasized building ego strength , adolescent autonomy , and insight into the emotional blocks to eating . BFST produced greater change on body-mass index than did EOIT , but both treatments produced comparable improvements on eating attitudes , body shape dissatisfaction , interoceptive awareness , depression/internalizing psychopathology , and eating-related family conflict . The implication s of these results for the clinician who treats adolescents with anorexia nervosa are discussed . J Dev Behav Pediatr 15:111–116 , 1994 . Index terms : anorexia nervosa , adolescents , family therapy , individual therapy Background Individual , family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa ( AN ) . Potential predictors of treatment outcome are explored . Method Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years ( adult units N = 12 ; adolescent N = 2 ) ( patients N = 177 ) . Results One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study . Following inpatient care , physical improvement was moderate/good with a large increase in BMI , although most patients continued to have a clinical level of eating disorder symptoms at discharge . The potentially modifiable predictors of outcome included confidence to change , social functioning and carer expressed emotion and control . Conclusions Overall , the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness . Adolescents had a better response . Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms . As predicted by the carer interpersonal maintenance model , carer behaviour may influence the response to inpatient care , as may improved social functioning and confidence to change BACKGROUND Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa . AIMS To evaluate the effectiveness of three readily available National Health Service treatments for adolescents ( aged 12 - 18 years ) with anorexia nervosa . METHOD Multicentre r and omised controlled trial of 167 young people comparing in-patient , specialist out-patient and general child and adolescent mental health service ( CAMHS ) treatment .  RESULTS Each group made considerable progress at 1 year , with further improvement by 2 years . Full recovery rates were poor ( 33 % at 2 years , 27 % still with anorexia nervosa ) . Adherence to in-patient treatment was only 50 % . Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat , although some CAMHS out- patients were subsequently admitted on clinical grounds . In-patient treatment ( r and omised or after out-patient transfer ) predicted poor outcomes . CONCLUSIONS First-line in-patient psychiatric treatment does not provide advantages over out-patient management . Out-patient treatment failures do very poorly on transfer to in-patient facilities BACKGROUND In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high . Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home . We investigated the safety and efficacy of DP after short inpatient care compared with continued IP . METHODS For this multicentre , r and omised , open-label , non-inferiority trial , we enrolled female patients ( aged 11 - 18 years ) with anorexia nervosa from six centres in Germany . Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa . We used a computer-generated r and omisation sequence to r and omly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) . The treatment programme and treatment intensity in both study groups were identical . The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 0·75 kg/m(2 ) ) . Analysis was done by modified intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number Register , number IS RCT N67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 . FINDINGS Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we r and omly allocated to treatment : 85 to IP and 87 to DP . DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 0·46 kg/m(2 ) in favour of DP ( 95 % CI , -0·11 to 1·02 ; pnon-inferiority<0·0001 ) . The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) . Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP  attempted suicide 3 months after she was discharged . INTERPRETATION DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission . Thus , DP might be a safe and less costly alternative to IP . Our results justify the broad implementation of this approach . FUNDING German Ministry for Education and Research OBJECTIVE Anorexia nervosa ( AN ) in adults has poor outcomes , and treatment evidence is limited . This study evaluated the efficacy and acceptability of a novel , targeted psychological therapy for AN ( Maudsley Model of Anorexia Nervosa Treatment for Adults ; MANTRA ) compared with Specialist Supportive Clinical Management ( SSCM ) . METHOD One hundred forty-two out patients with broadly defined AN ( body mass index [ BMI ] ≤ 18.5 kg/m² ) were r and omly allocated to receive 20 to 30 weekly sessions ( depending on clinical severity ) plus add-ons ( 4 follow-up sessions , optional sessions with dietician and with carers ) of MANTRA ( n = 72 ) or SSCM ( n = 70 ) . Assessment s were administered blind to treatment condition at baseline , 6 months , and 12 months after r and omization . The primary outcome was BMI at 12 months . Secondary outcomes included eating disorders symptomatology , other psychopathology , neuro-cognitive and social cognition , and acceptability . Additional service utilization was also assessed . Outcomes were analyzed using linear mixed models . RESULTS Both treatments result ed in significant improvements in BMI and reductions in eating disorders symptomatology , distress levels , and clinical impairment over time , with no statistically significant difference between groups at either 6 or 12 months . Improvements in neuro-cognitive and social-cognitive measures over time were less consistent . One SSCM patient died . Compared with SSCM , MANTRA patients rated their treatment as significantly more acceptable and credible at 12 months . There was no significant difference between groups in additional service consumption . CONCLUSIONS Both treatments appear to have value as first-line outpatient interventions for patients with broadly defined AN . Longer term outcomes remain to be evaluated Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group There are no controlled studies of the long term impact of treatment on the evolution of anorexia nervosa , although it is clear that life can sometimes be saved in the short term and that a variety of pharma cological and behavioural approaches can have a short term and limited effect on the low body weight control mechanisms of the patient . During the past 20 years , the second author has run an established in patient combined  behaviour and psychotherapeutic treatment programme  for patients with anorexia nervosa involving restoration of body weight to matched population levels coupled with individual and family psychotherapy ( Crisp , 1967 ) . He believes that this approach does have an impact on the course of the disorder ( Crisp , 1980 ) . However , it is difficult to evaluate it in total in a controlled experimental fashion since , in the event , it is impossible to deny any patient a treatment which almost always has the short term . effect of her gaining weight back to normal adult levels . In recent years , therefore , an alternative strategy has developed in the unit in which specific treatments ( e.g. the impact of tricyclic drugs ( Lacey and Crisp , 1980 ) are experimentally superimposed on the basic treatment programme . This paper reports the impact of a social skills programme exhibited on this basis . Two case reports ( Lang , 1965 and Argyle et a ! , 1974a ) describe the efficacy of behavioural social anxiety treatment  for anorexia nervosa . These studies are limited in diag nostic detail . Wolpe ( 1975 ) advocates the value of the comprehensiveness of a behavioural analysis in treating anorexianervosathatwould includean assessment of the symptom of social anxiety within the clinical condition . A controlled study by Argyle et a ! ( 1974b ) indicates the efficiency of  social skills treat ment as well as brief psychotherapy in positively influencing social ease in a patient population . How ever , no experimental studies are reported on the impact of a behaviourally orientated treatment for social anxiety  on the course of recovery for anorexia nervosa . This treatment was introduced because anorectics are known to be socially isolated and to have low self-esteem ( Crisp , 1970 ; Pillay and Crisp , 1977 ) . Furthermore , previous follow-up studies have revealed that those who have recovered often become socially anxious despite their involvement in psycho therapy directed at this area of difficulty ( Stonehill and Crisp , 1977 ; Crisp , 1980 ) . The hypothesis was that social skills training within the established in-patient treatment programme would lead to a greater degree of recovery from anorexia nervosa at one year follow-up as measured by the percentage matched population mean weight of the patients , and furthermore that these patients would be less socially anxious than those who had not received suchtreatment Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide . The seriousness of the disorder requires extensive knowledge of effective treatment options . However , evidence for treatment efficacy in this area is remarkably weak . A recent Cochrane review states that there is an urgent need for large , well- design ed treatment studies for patients with anorexia nervosa . The aim of this particular multi-centre study is to evaluate the efficacy of two st and ardized outpatient treatments for patients with anorexia nervosa :  focal psychodynamic ( FPT ) and cognitive behavioural therapy ( CBT ) . Each therapeutic approach is compared to a " treatment-as-usual " control group . Methods / Design 237 patients meeting eligibility criteria are r and omly and evenly assigned to the three groups – two intervention groups ( CBT and FPT ) and one control group . The treatment period for each intervention group is 10 months , consisting of 40 sessions respectively . Body weight , eating disorder related symptoms , and variables of therapeutic alliance are measured during the course of treatment . Psychotherapy sessions are audiotaped for adherence monitoring . The treatment in the control group , both the dosage and type of therapy , is not regulated in the study protocol , but rather reflects the current practice of established outpatient care . The primary outcome measure is the body mass index ( BMI ) at the end of the treatment ( 10 months after r and omization ) . Discussion The study design surmounts the disadvantages of previous studies in that it provides a r and omized controlled design , a large sample size , adequate inclusion criteria , an adequate treatment protocol , and a clear separation of the treatment conditions in order to avoid contamination . Nevertheless , the study has to deal with difficulties specific to the psychopathology of anorexia nervosa . The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol . However , because patients are difficult to recruit and often ambivalent about treatment , a drop-out rate of 30 % is assumed for sample size calculation . Due to the ethical problem of denying active treatment to patients with anorexia nervosa , the control group is defined as " treatment-as-usual".Trial registration Current Controlled Trials IS RCT BACKGROUND Little is known about the outcome of involving families in the treatment of adults with anorexia nervosa . Carers of people with anorexia nervosa experience significant levels of distress . This may contribute to unhelpful behaviours which maintain the illness . AIMS To evaluate the effectiveness and acceptability of family workshops with educational and skills-based components as compared to individual family work . METHOD An exploratory r and omised controlled trial of two forms of family intervention was conducted for in patients with anorexia nervosa ( n = 48 ) and their family members on a specialised unit for adults . RESULTS In both groups , there was an improvement in patients ' BMI and a reduction in carers ' distress . There were no differences between groups . CONCLUSION Preliminary findings suggest that workshop-based intervention with two families might be as effective as an individually focused family intervention . This may offer a more cost-effective intervention for this treatment-resistant group CONTEXT Evidence -based treatment trials for adolescents with anorexia nervosa are few . OBJECTIVE To evaluate the relative efficacy of family-based treatment ( FBT ) and adolescent-focused individual therapy ( AFT ) for adolescents with anorexia nervosa in full remission . DESIGN R and omized controlled trial . SETTING Stanford University and The University of Chicago ( April 2005 until March 2009 ) . PARTICIPANTS One hundred twenty-one participants , aged 12 through 18 years , with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement . Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT . Participants were assessed at baseline , end of treatment ( EOT ) , and 6 months ' and 12 months ' follow-up posttreatment . MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight ( ≥95 % of expected for sex , age , and height ) and mean global Eating Disorder Examination score within 1 SD of published means . Secondary outcome measures included partial remission rates ( > 85 % of expected weight for height plus those who were in full remission ) and changes in body mass index percentile and eating-related psychopathology . RESULTS There were no differences in full remission between treatments at EOT . However , at both the 6- and 12-month follow-up , FBT was significantly superior to AFT on this measure . Family-based treatment was significantly superior for partial remission at EOT but not at follow-up . In addition , body mass index percentile at EOT was significantly superior for FBT , but this effect was not found at follow-up . Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT , but there were no differences at follow-up . CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT , FBT was more effective in facilitating full remission at both follow-up points . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00149786 Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not BACKGROUND There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa ( AN ) . The aim of this study was to compare three psychological treatments for AN : Specialist Supportive Clinical Management , Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy . METHOD A multi-centre r and omised controlled trial was conducted with outcomes assessed at pre- , mid- and post-treatment , and 6- and 12-month follow-up by research ers blind to treatment allocation . All analyses were intention-to-treat . One hundred and twenty individuals meeting diagnostic criteria for AN were recruited from outpatient treatment setting s in three Australian cities and offered 25 - 40 sessions over a 10-month period . Primary outcomes were body mass index ( BMI ) and eating disorder psychopathology . Secondary outcomes included depression , anxiety , stress and psychosocial impairment . RESULTS Treatment was completed by 60 % of participants and 52.5 % of the total sample completed 12-month follow-up . Completion rates did not differ between treatments . There were no significant differences between treatments on continuous outcomes ; all result ed in clinical ly significant improvements in BMI , eating disorder psychopathology , general psychopathology and psychosocial impairment that were maintained over follow-up . There were no significant differences between treatments with regard to the achievement of a healthy weight ( mean = 50 % ) or remission ( mean = 28.3 % ) at 12-month follow-up . CONCLUSION The findings add to the evidence base for these three psychological treatments for adults with AN , but the results underscore the need for continued efforts to improve outpatient treatments for this disorder . Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN 12611000725965 ) Technological advancements allow new approaches to psychotherapy via electronic media . The eating disorder literature currently contains no studies on internet intervention in anorexia nervosa ( AN ) . This study presents a RCT on an internet-based relapse prevention program ( RP ) over nine months after inpatient treatment for AN . The sample comprised 258 women , r and omized to the RP or treatment as usual ( TAU ) .  Expert- and self-ratings were evaluated by intent-to-treat analyses . Concerning age , age at onset and comorbidity , both groups were comparable at r and omization . During the RP , the intervention group gained weight while the TAU group had minimal weight loss .  RP completers gained significantly more body weight than patients in the TAU condition . Group-by-time comparisons for eating-related cognitions and behaviors and general psychopathology showed a significantly more favorable course in the RP program for " sexual anxieties " and " bulimic symptoms " ( interview ) , and " maturity fears " and " social insecurity " ( EDI-2 ) . General psychopathology showed no significant group-by-time interaction . Important factors for successful relapse prevention were adherence to the intervention protocol and increased spontaneity . Considering the unfavorable course and chronicity of anorexia nervosa ( AN ) , internet-based relapse prevention in AN following inpatient treatment appears a promising approach . Future internet-based programs may be further improved and enhanced BACKGROUND Young people with anorexia nervosa are often admitted to hospital for treatment . As well as being disruptive to school , family and social life , in-patient treatment is expensive , yet cost-effectiveness evidence is lacking . AIMS Cost-effectiveness analysis of three treatment strategies for adolescents with anorexia nervosa . METHOD UK multicentre r and omised , controlled trial comparing in-patient psychiatric treatment , specialist out-patient treatment and general out-patient treatment .  Outcomes and costs assessed at baseline , 1 and 2 years . RESULTS There were 167 young people in the trial . There were no statistically significant differences in clinical outcome between the three groups at 2 years . The specialist out-patient group was less costly over the 2-year follow-up ( mean total cost 26 738 UK pounds ) than the in-patient ( 34 531 UK pounds ) and general out-patient treatment ( 40 794 UK pounds ) groups , but this result was not statistically significant . Exploration of the uncertainty associated with the costs and effects of the three treatments suggests that specialist out-patient treatment has the highest probability of being cost-effective . CONCLUSIONS On the basis of cost-effectiveness , these results support the provision of specialist out-patient services for adolescents with anorexia nervosa BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements .  Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain
There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .