Current Therapeutic Approaches to Anorexia Nervosa: State of the Art

Anorexia nervosa (AN) is a devastating psychiatric disorder characterized by extreme restriction of food intake and low body weight, both associated with significant medical and psychological morbidity. The clinical severity of AN has prompted the consideration and study of behavioral and pharmacological treatments in efforts to establish empirically based methods to reduce the burden of the disorder. Among adolescents, family-based treatment is considered a first-line behavioral treatment. Research continues to explore the efficacy of family-based treatment and predictors of treatment response to further improve outcomes. Several behavioral treatments for adults also exist, including cognitive-behavioral therapy, exposure and response prevention, third-wave acceptance-based treatments, and supportive psychotherapy, all of which help to improve symptoms and promote modest weight gain. Despite this, no one treatment is considered superior, and all existing behavioral approaches leave a proportion of adults symptomatic or at a high risk of relapse. As such, among adults, there is continued need for development of novel, mechanism-based approaches to better target the core symptoms of AN. Although antidepressants impart little benefit on weight or symptoms, the second-generation antipsychotic olanzapine has shown ability to promote modest weight gain in outpatients with AN. Most recently, the field's evolving conceptualization of AN as a biologically based disorder coupled with technological advancements has led to consideration of varying neuromodulation strategies as a potential therapeutic approach that remains under investigation.     

Vaspin (but not neuropeptide B or neuropeptide W) as a possible predictor of body weight normalization in anorexia nervosa

IntroductionThe aim of the study was to evaluate the correlation between the nutritional status of patients with anorexia nervosa (AN) and levels of vaspin (VASP), neuropeptide B (NPB), neuropeptide W (NPW) and total antioxidant status (TAS).Material and methodsNinety serum samples collected from 30 teenage female patients during the acute stage of AN and 30 healthy persons (CONTR) were subjected to biochemical analysis; patients with AN were examined at the beginning of the study (AN-I) and after hospitalization (AN-II), as a result of which partial stabilization of anthropometric measurements was achieved (an increase of body mass index (BMI) by 3.5 kg/m²).ResultsVaspin levels dropped at the end of the hospitalization (compared to AN-I, p < 0.05), achieving values comparable to the CONTR; moreover there was a positive correlation between VASP level and the achieved body weight in AN-II (p < 0.05). Positive correlations were also noted with regard to VASP vs. NPB in AN-I (p < 0.02) (and AN-II, p < 0.013), as well as in the case of VASP vs. NPW in the same groups (p < 0.02 and p < 0.015, respectively). NPB concentration was higher in AN-I (p < 0.05) and AN-II (p < 0.018) than in CONTR, whereas there were no differences (p > 0.05) with regard to levels of VASP, NPW, or TAS.ConclusionsThe high level of NPB despite treatment and normalization of VASP level may suggest that there are chronic neuroendocrine disorders at play in anorexia nervosa.     

Drop‐out from inpatient treatment for anorexia nervosa: can risk factors be identified at point of admission?

Despite renewed interest in drop‐out from eating disorders treatment, few studies have investigated the issue in respect to the most expensive and intensive form of treatment, that is, inpatient treatment for anorexia nervosa (AN). This study investigates whether risk of treatment drop‐out can be determined from information routinely collected at point of admission. Using information from a multi‐site database collected in Australia and New Zealand, demographic and clinical data at point of admission were collated for 213 inpatient treatment episodes. One in five admissions ended with the patient unilaterally deciding to leave treatment without clinician endorsement. A lower body mass index, AN purging subtype and active fluid restriction made significant independent contributions to this risk. Drop‐out remains a highly disruptive method of discharge and while there is utility in predicting those most at risk, few variables commonly collated by clinicians contribute to their identification. The implications for clinical practice and future research are discussed. Copyright © 2003 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Treatment of Perfectionism within the Eating Disorders: A Pilot Study

The aim of this pilot study was to investigate the impact of the direct treatment of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty‐one participants, attending day hospital treatment, participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician‐lead cognitive behavioural treatment for perfectionism (TAU + P). Linear mixed model analysis revealed no significant interaction effects but significant main effects for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment of perfectionism. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Trends in Anorexia Nervosa Research: An Analysis of the Top 100 Most Cited Works

Analysis of highly cited papers provides unique insights into the status of research in a given field. We sought to identify the top 100 most highly cited papers in the field of anorexia nervosa (AN). A free, publically accessible software was used to conduct an online search of publications with accompanying citation data. Search terms were selected to focus on papers dealing predominantly with AN, and the results manually screened to exclude out‐of‐scope publications. Papers in bulimia nervosa, eating disorder not otherwise specified and binge‐eating disorder, were not included. The top 100 most highly cited papers in the AN field were identified. Of these, 34 garnered greater than 400 citations, classifying them as ‘citation classics’. These works were divided into five categories, those dealing with epidemiological trends, medical/psychiatric comorbidities, treatment, mechanisms of disease and measurement/classification. Publications examining the epidemiology and underlying mechanisms of AN account for the majority of the top 100 papers. Scales and measurement tools have had the greatest impact, garnering the greatest number of average citations per paper. Although reasonably diverse, the top 100 papers highlight areas still lagging behind, including the neuroscience of AN as well as research into novel treatment strategies. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.