A double-blind trial of delta 9-tetrahydrocannabinol in primary anorexia nervosa. An open trial of fluoxetine in patients with anorexia nervosa. How effective and safe is medical cannabis as a treatment of mental disorders? A systematic review Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. Changes in IGF-I, urinary free cortisol and adipokines during dronabinol therapy in anorexia nervosa: Results from a randomised, controlled trial. Outcome of anorexia nervosa: a case-control study. Dronabinol in severe, enduring anorexia nervosa: a randomized controlled trial. A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa Cannabidiol in Humans—The Quest for Therapeutic Targets Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa Predictors of mortality in eating disorders. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial Cannabidiol Attenuates the Appetitive Effects of Δ9-Tetrahydrocannabinol in Humans Smoking Their Chosen Cannabis Adolescent-onset anorexia nervosa: 18-year outcome. Does internet-based prevention reduce the risk of relapse for anorexia nervosa? Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial A pilot open case series of ethyl-EPA supplementation in the treatment of anorexia nervosa. Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. Burden of eating disorders in 5-13-year-old children in Australia.
Δ9-Tetrahydrocannabinol ( Δ9-THC ) , the most prominent psychoactive cannabinoid in Cannabis sativa L. ( marijuana ) , has been reported to have properties of appetite stimulation , promotion of weight gain , and antiemetic efficacy in selected patient population s. In this 4-week , double-blind , crossover study , 11 female patients with primary anorexia nervosa ( PAN ) were evaluated on Δ9-THC and on an active placebo , diazepam . All patients participated in a st and ardized behavior modification treatment program . The following data were obtained : ( 1 ) daily weight , ( 2 ) daily caloric intake , and ( 3 ) weekly psychiatric assessment s. The two groups were comparable on all measures at baseline except for two items on the behavioral rating scales . The only significant differences found between the changes over time on Δ9-THC versus diazepam were more pathology on Δ9-THC for somatization , interpersonal sensitivity , and sleep disturbance . Three patients experienced severe dysphoric reactions consisting of paranoid ideation and feelings of loss of control during Δ9-THC administration . One week after the study ended , each subject was given the highest dose level of Δ8-THC achieved in the study , and periodic blood sample s were obtained coincident with self-rated “ subjective high ” assessment s and pulse measurements . Quantitative analyses of these sample s indicated peak times of 1 to 5 hours postdose for Δ9- THC and for its primary active metabolite , 11-hydroxy-THC , which generally coincided with peak times for “ subjective high ” and pulse rate . The results of this clinical investigation suggest that Δ9-THC is not efficacious , in short-term administration , in the treatment of primary anorexia nervosa and is associated with significant psychic disturbance in some PAN patients BACKGROUND Anorexia nervosa is a disorder of unknown etiology with a high rate of relapse and no known treatment . Because anorexia nervosa shares some similarities with obsessive compulsive disorder , we hypothesized that a serotonin-specific medication might be useful in the treatment of this illness . METHOD We administered an open trial of fluoxetine to 31 patients with DSM-III-R anorexia nervosa . Most anorexics were started on fluoxetine treatment after inpatient weight restoration and then discharged from the hospital and followed up as out patients . RESULTS At the time of follow-up ( 11 + /- 6 months on fluoxetine ) , 29 of the 31 patients had maintained their weight at or above 85 % average body weight ( 97 % + /- 13 % average body weight for the group ) . We judged response as good in 10 , partial in 17 , and poor in 4 anorexics as measured by improvements in eating behavior , mood , and obsessional symptoms . Restrictor anorexics responded significantly better than bulimic and /or purging-type anorexics . CONCLUSION This open trial suggests that fluoxetine may help patients with anorexia nervosa maintain a healthy body weight as out patients . The reasons for the positive effects of fluoxetine are uncertain , but the agent may help by improving eating behavior and /or reducing obsessionality , depression , and anxiety . It is important to emphasize that this was not a double-blind , placebo-controlled study . Thus we can not be certain of the efficacy of fluoxetine and caution that fluoxetine should not be used as the sole treatment of anorexia nervosa at this time We conducted a review of systematic review s ( SRs ) and r and omized-controlled trials ( RCTs ) to analyze efficacy and safety of cannabis-based medication in patients with mental disorders . Five data bases were systematic ally search ed ( 2006—August 2018 ) ; 4 SRs ( of 11 RCTs ) and 14 RCTs ( 1629 participants ) were included . Diagnoses were : dementia , cannabis and opioid dependence , psychoses/schizophrenia , general social anxiety , posttraumatic stress disorder , anorexia nervosa , attention-deficit hyperactivity disorder , and Tourette`s disorder . Outcome variables were too heterogeneous to conduct a meta- analysis . A narrative synthesis method was applied . The study quality was assessed using the risk-of-bias tool and SIGN-checklists . THC- and CBD-based medicines , given as adjunct to pharmaco- and psychotherapy , were associated with improvements of several symptoms of mental disorders , but not with remission . Side effects occurred , but severe adverse effects were mentioned in single cases only . In order to provide reliable treatment recommendations , more and larger RCTs with follow-up assessment s , consistent outcome measures and active comparisons are needed 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 OBJECTIVE Anorexia nervosa ( AN ) is characterised by complex neuroendocrine disturbances due to severe underweight , physical hyperactivity and purging behaviour . Cannabinoid agonists are used to palliate cachexia of various causes , but their interactions with the hormonal systems that are involved in energy metabolism have not been previously described in humans . Therefore we found it of interest to assess interactions between the synthetic cannabinoid agonist dronabinol and insulin-like growth factor I ( IGF-I ) , urinary free cortisol ( UFC ) and adipokines in patients with chronic AN . DESIGN This was a prospect i ve , double-blind r and omised crossover study , conducted at a specialised care centre for eating disorders . The results are based on twenty-four adult women with chronic AN , who completed the study . The participants received dronabinol ( oral capsules , 5 mg daily ) and matching placebo over four weeks , separated by a four-week washout period . Bioactive IGF was determined by a cell-based bioassay , whereas total IGF-I , IGFBP-2 and -3 and the two adipokines leptin and adiponectines were measured by immunoassays . The UFC excretion was determined by mass spectrometry . RESULTS As previously reported , dronabinol treatment caused a small , yet significant increase in BMI as compared to placebo ( + 0.23 kg/m(2 ) ; P = 0.04 ) . This modest weight gain predicted a corresponding increase in bioactive IGF-I , while the amount of daily energy expenditure due to physical activity had a comparable but opposite effect . Nevertheless , neither IGF-I , bioactive IGF nor the IGFBPs levels changed significantly during dronabinol intervention as compared to placebo . Adiponectin also remained unaffected by the weight gain , whereas plasma leptin showed a transient increase at three weeks ( P < 0.05 ) . UFC levels were decreased during dronabinol intervention . CONCLUSION Our results showed that low-dosage therapy with the synthetic cannabinoid agonist dronabinol affected neither the concentration nor the activity of the circulating IGF-system in women with severe and chronic AN . However , our results suggest that such treatment may alleviate the increased hypothalamic-pituitary-adrenal axis activity seen in these patients OBJECTIVE Although there have been many studies of the outcome of anorexia nervosa , method ological weaknesses limit their interpretation . The authors used a case-control design to try to improve knowledge about the outcome of anorexia nervosa . METHOD All new female patients referred to an eating disorders service between Jan. 1 , 1981 , and Dec. 31 , 1984 , who had probable or definite anorexia nervosa were eligible for inclusion . Of these women , 86.4 % ( N = 70 ) were located and agreed to participate . The comparison group ( N = 98 ) was a r and om community sample .  All subjects were interviewed with a structured diagnostic instrument . RESULTS A minority of the patients ( 10 % ) continued to meet the criteria for anorexia nervosa a mean of 12 years after initial referral . Even among those who no longer met these criteria , relatively low body weight and cognitive features characteristic of anorexia nervosa ( perfectionism and cognitive restraint ) persisted . The rates of lifetime comorbid major depression , alcohol dependence , and a number of anxiety disorders were very high . CONCLUSIONS In the managed care/brief treatment era , therapeutic approaches with an excessive focus on weight gain that neglect the detection and treatment of associated psychological features and comorbidity may be inappropriate . Anorexia nervosa is a serious psychiatric disorder with substantial morbidity OBJECTIVE The evidence for pharmacological treatment of severe , longst and ing anorexia nervosa ( AN ) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs . The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist on body weight and eating disorder-related psychopathological personality traits in women with severe , enduring AN . METHOD This add-on , prospect i ve , r and omized , double blind , controlled crossover study was conducted between 2008 and 2011 at a specialized care center for eating disorders . Twenty-five women over 18 years with AN of at least 5 years duration were r and omized to treatment with either dronabinol-placebo or placebo-dronabinol .  In addition to the st and ardized baseline therapeutic regime , the participants received dronabinol , 2.5 mg twice daily for 4 weeks and matching placebo for 4 weeks , separated by a 4-week wash-out period . Primary outcome was the mean change in body weight . Secondary outcome was score changes on the Eating Disorder Inventory-2 ( EDI-2 ) . Data were analyzed for the 24 patients who completed the trial . RESULTS During dronabinol treatment , participants gained 0.73 kg ( t = 2.86 , df = 22 , p < 0.01 ) above placebo without significant psychotropic adverse events . Dronabinol significantly predicted weight gain in a multiple linear regression including EDI-2 body dissatisfaction score and leptin . EDI-2 subscale scores showed no significant changes over time . DISCUSSION Dronabinol therapy was well tolerated . During four weeks of exposure it induced a small but significant weight gain in the absence of severe adverse events In anorexia nervosa ( AN ) , volitional inhibition of rewarding behaviors , such as eating , involves a conflict between the desire to suppress appetite and the inherent motive to consume . This conflict is thought to have costs that carry over into daily life , e.g. , triggering negative affect and /or recurring ruminations , which may ultimately impact long term outcome . Hence , increasing research effort is being dedicated to underst and the link between emotional and ruminative processes in the etiology and maintenance of AN . We investigated whether affective states influence disorder-related rumination in AN applying “ ecological momentary assessment ” , a method which allows the experimenter to gain insight into psychological processes in the natural environment and assess data in real time . Participants ( AN = 37 , healthy controls = 33 ) were given a smartphone for 14 days .  A ringtone signaled at six r and om time-points each day to fill in a question naire , which gauged disorder-typical thoughts about food and weight as well as affective state . Analyses , applying hierarchical linear models confirmed that AN patients spend more time thinking about food , body shape and weight than controls ( p < 0.001 ) . Additionally , the results support the hypothesis that momentary negative affect ( but not baseline depression ( p = 0.56 ) or anxiety symptoms ( p = 0.60 ) are positively associated with a higher amount of disorder-related rumination in patients ( p < 0.001 ) . Our findings are in line with theories which cl aim that ruminative thinking induces a vulnerability to negative stimuli which , in turn , fosters heightened negative affect . Thus , therapeutic interventions could be improved by implementing modules that specifically target disorder-related rumination Cannabidiol ( CBD ) , a major phytocannabinoid constituent of cannabis , is attracting growing attention in medicine for its anxiolytic , antipsychotic , antiemetic and anti-inflammatory properties . However , up to this point , a comprehensive literature review of the effects of CBD in humans is lacking . The aim of the present systematic review is to examine the r and omized and crossover studies that administered CBD  to healthy controls and to clinical patients . A systematic search was performed in the electronic data bases PubMed and EMBASE using the key word “ cannabidiol ” . Both monotherapy and combination studies ( e.g. , CBD + ∆9-THC ) were included . A total of 34 studies were identified : 16 of these were experimental studies , conducted in healthy subjects , and 18 were conducted in clinical population s , including multiple sclerosis ( six studies ) , schizophrenia and bipolar mania ( four studies ) , social anxiety disorder ( two studies ) , neuropathic and cancer pain ( two studies ) , cancer anorexia ( one study ) , Huntington ’s disease ( one study ) , insomnia ( one study ) , and epilepsy ( one study ) . Experimental studies indicate that a high-dose of inhaled/intravenous CBD is required to inhibit the effects of a lower dose of ∆9-THC . Moreover , some experimental and clinical studies suggest that oral/oromucosal CBD may prolong and /or intensify ∆9-THC-induced effects , whereas others suggest that it may inhibit ∆9-THC-induced effects . Finally , preliminary clinical trials suggest that high-dose oral CBD ( 150–600 mg/d ) may exert a therapeutic effect for social anxiety disorder , insomnia and epilepsy , but also that it may cause mental sedation . Potential pharmacokinetic and pharmacodynamic explanations for these results are discussed BACKGROUND Anorexia nervosa is an often chronic disorder with high morbidity and mortality . Many people relapse after weight restoration . This study was design ed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms . METHODS We administered a double-blind placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa . Anorexics were r and omly assigned to fluoxetine ( n = 16 ) or a placebo ( n = 19 ) after inpatient weight gain and then were observed as out patients for 1 year . RESULTS Ten of 16 ( 63 % ) subjects remained on fluoxetine for a year , whereas only three of 19 ( 16 % ) remained on the placebo for a year ( p = .006 ) . Those subjects remaining on fluoxetine for a year had reduced relapse as determined by a significant increase in weight and reduction in symptoms . CONCLUSIONS This study offers preliminary evidence that fluoxetine may be useful in improving outcome and preventing relapse of patients with anorexia nervosa after weight restoration BACKGROUND Anorexia nervosa , but not bulimia nervosa , has one of the highest mortality rates among psychiatric disorders . However , potential predictors of mortality , such as comorbid psychiatric illnesses , remain unclear . We sought to determine mortality ratios and predictors of fatal outcome in women diagnosed as having anorexia or bulimia nervosa . METHODS Women ( N = 246 ) diagnosed as having either DSM-IV anorexia nervosa ( n = 136 ) or bulimia nervosa ( n = 110 ) between January 1 , 1987 , and December 31 , 1991 , participated in a prospect i ve longitudinal study . Vital status was determined by ongoing contact and a National Death Index search as of December 1998 ( overall ascertainment , 99.8 % ) and telephone contact as of October 2000 ( ascertainment , 95.0 % ) . RESULTS Eleven women died . St and ardized mortality ratios were elevated for all causes of mortality ( 11.6 ; 95 % confidence interval , 5.5 - 21.3 ) and suicide ( 56.9 ; 95 % confidence interval , 15.3 - 145.7 ) in anorexia nervosa but not for death ( 1.3 ; 95 % confidence interval , 0.0 - 7.2 ) in bulimia nervosa . Predictors of mortality in anorexia nervosa included severity of alcohol use disorder during follow-up ( P<.001 ) . Hospitalization for an affective disorder before baseline assessment seemed to protect women from a fatal outcome ( P<.001 ) . CONCLUSIONS Physicians treating patients with anorexia nervosa should carefully assess patterns of alcohol use during the course of care because one third of women who had alcoholism and died had no history of alcohol use disorder at intake STUDY DESIGN Systematic review and best evidence synthesis . OBJECTIVES To describe the prevalence and incidence of  neck pain and disability in workers ; to identify risk factors for neck pain in workers ; to propose an etiological diagram ; and to make recommendations for future research . SUMMARY OF BACKGROUND DATA Previous review s of the etiology of neck pain in workers relied on cross-sectional evidence . Recently published cohorts and r and omized trials warrant a re- analysis of this body of research . METHODS We systematic ally search ed Medline for literature published from 1980 - 2006 . Retrieved articles were review ed for relevance . Relevant articles were critically appraised . Articles judged to have adequate internal validity were included in our best evidence synthesis . RESULTS One hundred and nine papers on the burden and determinants of neck pain in workers were scientifically admissible . The annual prevalence of neck pain varied from 27.1 % in Norway to 47.8 % in Québec , Canada . Each year , between 11 % and 14.1 % of workers were limited in their activities because of neck pain . Risk factors associated with neck pain in workers include age , previous musculoskeletal pain , high quantitative job dem and s , low social support at work , job insecurity , low physical capacity , poor computer workstation design and work posture , sedentary work position , repetitive work and precision work . We found preliminary evidence that gender , occupation , headaches , emotional problems , smoking , poor job satisfaction , awkward work postures , poor physical work environment , and workers ' ethnicity may be associated with neck pain . There is evidence that interventions aim ed at modifying workstations and worker posture are not effective in reducing the incidence of neck pain in workers . CONCLUSION Neck disorders are a significant source of pain and activity limitations in workers . Most neck pain results from complex relationships between individual and workplace risk factors . No prevention strategies have been shown to reduce the incidence of neck pain in workers Purpose The level of physical activity is inappropriately high in up to 80 % of the patients suffering of anorexia nervosa ( AN ) , as a result of conscious efforts to lose weight , affect regulation and biological adaptive changes to starvation induced by hypothermia and neuroendocrine mechanisms . The purpose s of this paper were to ( 1 ) assess the effect of dronabinol — a synthetic cannabinoid agonist — on physical activity in patients with chronic and stable AN , and to ( 2 ) unravel the role of leptin and cortisol in this process . Methods This prospect i ve , r and omised , double-blind , crossover study was conducted at a specialised care centre for eating disorders . Twenty-four adult women with AN of at least 5-year duration received either the dronabinol-placebo or placebo-dronabinol sequence .  Physical activity was monitored during the fourth week of each intervention . Body weight , leptin and urinary free cortisol excretion were measured repeatedly during the trial . Changes in behavioural dimensions related to AN were assessed by Eating Disorder Inventory-2 . Results The total duration of physical activity did not change , while its average intensity increased by 20 % ( P = 0.01 ) during dronabinol therapy , result ing in an increased energy expenditure with 68.2 kcal/day ( P = 0.01 ) above placebo . Conclusions This r and omised , double-blind study revealed that cannabinoid agonist treatment was associated with a modest increase in physical activity in adult women with severe and longst and ing AN . Additionally , we detected a strong relationship between the circulating levels of leptin and physical activity in these chronically undernourished patients Worldwide cannabis dependence is increasing , as is the concentration of Δ9-tetrahydrocannabinol ( THC ) in street cannabis . At the same time , the concentration of the second most abundant cannabinoid in street cannabis ,  cannabidiol  ( CBD ) , is decreasing . These two cannabinoids have opposing effects both pharmacologically and behaviorally when administered in the laboratory . No research has yet examined how the ratio of these constituents impacts on the appetitive/reinforcing effects of cannabis in humans . A total of 94 cannabis users were tested 7 days apart , once while non-intoxicated and once while acutely under the influence of their own chosen smoked cannabis on dependence-related measures . Using an unprecedented methodology , a sample of cannabis ( as well as saliva ) was collected from each user and analyzed for levels of cannabinoids . On the basis of CBD : THC ratios in the cannabis , individuals from the top and bottom tertiles were directly compared on indices of the reinforcing effects of drugs , explicit liking , and implicit attentional bias to drug stimuli . When intoxicated , smokers of high CBD : THC strains showed reduced attentional bias to drug and food stimuli compared with smokers of low CBD : THC . Those smoking higher CBD : THC strains also showed lower self-rated liking of cannabis stimuli on both test days . Our findings suggest that CBD has potential as a treatment for cannabis dependence . The acute modulation of the incentive salience of drug cues by CBD may possibly generalize to a treatment for other addictive disorders BACKGROUND The long-term outcome of anorexia nervosa is insufficiently research ed . AIMS To study prospect ively the long-term outcome and prognostic factors in a representative sample of people with teenage-onset anorexia nervosa . METHOD Fifty-one people with anorexia nervosa , recruited by community screening and with a mean age at onset of 14 years were compared with 51 matched comparison individuals at a mean age of 32 years ( 18 years after disorder onset ) . All participants had been examined at ages 16 years , 21 years and 24 years . They were interviewed for Axis I psychiatric disorders and overall outcome ( Morgan-Russell assessment schedule and the Global Assessment of Functioning ) . RESULTS There were no deaths . Twelve per cent ( n=6 ) had a persisting eating disorder , including three with anorexia nervosa . Thirty-nine per cent of the anorexia nervosa group met the criteria for at least one psychiatric disorder . The general outcome was poor in 12 % . One in four did not have paid employment owing to psychiatric problems . Poor outcome was predicted by premorbid obsessive-compulsive personality disorder , age at onset of anorexia nervosa and autistic traits . CONCLUSIONS The 18-year outcome of teenage-onset anorexia nervosa is favourable in respect of mortality and persisting eating disorder 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 PURPOSE To compare the effects of cannabis extract ( CE ) , delta-9-tetrahydrocannabinol ( THC ) , and placebo ( PL ) on appetite and quality of life ( QOL ) in patients with cancer-related anorexia-cachexia syndrome ( CACS ) . PATIENTS AND METHODS Adult patients with advanced cancer , CACS , weight loss ( > or = 5 % over 6 months ) , and Eastern Cooperative Oncology Group ( ECOG ) performance status ( PS ) < or = 2 were r and omly assigned ( 2:2:1 ) to receive CE ( st and ardized for 2.5 mg THC and 1 mg cannabidiol ) or THC ( 2.5 mg ) or PL orally , twice daily for 6 weeks . Appetite , mood , and nausea were monitored daily with a visual analog scale ( VAS ) ; QOL was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ( composite score : questions 29 and 30 ) . Cannabinoid-related toxicity was assessed every 2 weeks . RESULTS Of 289 patients screened , 243 were r and omly assigned and 164 ( CE , 66 of 95 patients ; THC , 65 of 100 patients ; and PL , 33 of 48 patients ) completed treatment . At baseline , groups were comparable for age ( mean , 61 years ) , sex ( 54 % men ) , weight loss ( 32 % > or = 10 % ) , PS ( 13 % ECOG = 2 ) , antineoplastic treatment ( 50 % ) , appetite ( mean VAS score , 31/100 mm ) , and QOL ( mean score , 30/100 ) . Intent-to-treat analysis showed no significant differences between the three arms for appetite , QOL , or cannabinoid-related toxicity . Increased appetite was reported by 73 % , 58 % , and 69 % of patients receiving CE , THC , or PL , respectively . An independent data review board recommended termination of recruitment because of insufficient differences between study arms . CONCLUSION CE at the oral dose administered was well tolerated by these patients with CACS . No differences in patients ' appetite or QOL were found either between CE , THC , and PL or between CE and THC at the dosages investigated 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 Anorexia nervosa ( AN ) carries the highest risk of morbidity and mortality amongst psychiatric disorders . The efficacy of current treatment approaches is limited . Despite the fat-phobic nature of the disease , poly-unsaturated fatty acids ( PUFAs ) have not received much research attention . Patients who consume western diet , which is rich in n-6 PUFAs and trans-fatty acids , are likely to develop severe n-3 PUFA deficiency during self-induced starvation . Re-feeding programmes do not take into consideration n-3 EFA intake , possibly leading to further n-3 PUFA deficiency during weight restoration , and this might contribute to the maintenance of the disorder . To test this hypothesis , we carried out a systematic case series of E-EPA supplementation in the treatment of AN . Seven young patients received 1g/day E-EPA in addition to st and ard treatment , and were followed up for 3 months . Three of them recovered and four improved . R and omised controlled trials are warranted to examine the effectiveness of E-EPA  in AN further 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 > “ There are known knowns . These are things we know that we know . There are known unknowns . That is to say , there are things that we now know we do n't know . But there are also unknown unknowns . These are things we do not know we do n't know . ” > > —United States Secretary of Defense Donald Rumsfeld ( February 2002 ) > “ Thought is the wind , knowledge the sail , and mankind the vessel . ” > > August Hare ( 1792–1834 ) The international resuscitation community , under the auspices of the International Liaison Committee on Resuscitation ( ILCOR ) , has performed an exhaustive review of the published literature related to resuscitation and emergency cardiovascular care ( ECC ) . We had the opportunity to build on the detailed process developed over the past decade that facilitated the publication of the international consensus statement on therapeutic hypothermia1 and the Consensus on Cardiopulmonary Resuscitation ( CPR ) and ECC Science With Treatment Recommendations in 2005 (C2005).2 The overall process has been informed by the increasing evidence base behind good , systematic literature review s.3,4 There are , however , many questions that have never been addressed in a r and omized controlled trial , and much of the supporting scientific literature is at lower levels of evidence ( LOEs ) . In total , 356 worksheet authors from 29 countries throughout the world completed 411 worksheets on 277 topics . The information from these worksheets , with additional iterations from the writing groups and editorial board , makes up the evidence base from which the 2010 International Consensus on CPR and ECC Science with Treatment Recommendations ( CoSTR ) document is derived . As has been the process since the evidence evaluation for Guidelines 2000,5 volunteers from around the world were asked to perform systematic review s of the literature . These review s were conducted according to st and ardized instructions in completing the evidence worksheet template , and these worksheets were subsequently review ed in a detailed iterative process ( see www . ILCOR.org).6 A revised worksheet template ( based on that 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 OBJECTIVE To collect nationally representative epidemiological data on early-onset eating disorders ( EOEDs ) in children . DESIGN Prospect i ve , active surveillance using the Australian Paediatric Surveillance Unit with key informant design . SETTING Child health specialists in Australia ( July 2002 to June 2005 ) . PATIENTS Incident cases of EOEDs in children aged 5 - 13 years . MAIN OUTCOME MEASURES Disease rates , demographic characteristics , clinical features and complications , hospitalisation , psychological comorbidity , and concordance of clinical features with Diagnostic and statistical manual of mental disorders , fourth edition ( DSM-IV ) criteria . RESULTS We identified 101 children aged 5 - 13 years with EOEDs ( median age , 12.2 years ; range , 5.5 - 13.9 years ) , of whom one in four were boys . Most were hospitalised ( 78 % ) , and the mean duration of hospitalisation was 24.7 days ( range , 1 - 75 days ) . More than 70 % of in patients were admitted to specialised eating disorder units in paediatric teaching hospitals . Among in patients , 37 % met DSM-IV diagnostic criteria for anorexia nervosa ; although 61 % had life-threatening complications of malnutrition , only 51 % met weight criteria . Psychological symptoms were similar to those in adults with anorexia nervosa : 67 % of in patients met both psychological diagnostic criteria for anorexia nervosa ( fear of weight gain/fatness and misperception of body shape ) . Of 19 postmenarchal girls , 18 had secondary amenorrhoea . Nasogastric feeding  was used in 58 % of in patients , and 34 % received psychotropic medications . CONCLUSIONS This is the first prospect i ve national study of EOEDs . It demonstrates the limitations of applying DSM-IV diagnostic criteria for anorexia nervosa to young children ; the high proportion of boys affected by EOEDs ; and the significant psychological comorbidity and high frequency of hospitalisation associated with EOEDs . Potentially life-threatening medical complications are common at presentation , suggesting possible missed diagnoses and a need for education of health professionals . The study underlines the severity of EOEDs and the need for joint medical and psychiatric specialist management
The only properly design ed , low bias and highly powered study found a weight increasing effect  of dronabinol in AN , while the other , using Δ9-THC at a high dose , found no effect and where the dose may have counteracted the weight gaining effects due to adverse events .
Anorexia nervosa ( AN ) is a psychiatric disorder with a high mortality and unknown etiology , and effective treatment is lacking .
For decades , cannabis has been known to cause physical effects on the human body , including increasing appetite , which may be beneficial in the treatment of AN .
To systematic ally review the literature for evidence of an effect of cannabinoids on ( 1 ) weight gain , and ( 2 ) other outcomes , in AN .