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. A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Intensive enhanced cognitive behavioural therapy for severe and enduring anorexia nervosa: A longitudinal outcome study. Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study. Outcome of anorexia nervosa: a case-control study. Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa Inpatient Cognitive Behaviour Therapy for Anorexia Nervosa: A Randomized Controlled Trial Adolescent-onset anorexia nervosa: 18-year outcome. A comparison of short- and long-term family therapy for adolescent anorexia nervosa. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Does fluoxetine augment the inpatient treatment of anorexia nervosa? A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK–Italy study
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 The aim of this study was to compare two forms of outpatient treatment , educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa . Thirty patients were r and omly allocated to the two treatments . At one year , the group had gained 6.8 kg , 19/30 ( 63 % ) had a good or intermediate recovery in terms of nutritional outcome . The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters . In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases . Larger studies will be needed to determine the most effective form of treatment in this group OBJECTIVE This study aim ed to evaluate short- and long-term outcomes in patients with severe and enduring anorexia nervosa ( SE-AN ) , as compared with those with non SE-AN ( NSE-AN ) , both treated via an inpatient programme based on a " recovery model " approach . METHODS Sixty-six adult patients with anorexia nervosa ( AN ) were recruited from among consecutive referrals to a community-based eating disorder clinic offering inpatient enhanced cognitive behavioural therapy for eating disorders ( CBT-E ) . Body mass index ( BMI ) , and Eating Disorder Examination ( EDE ) and Brief Symptom Inventory ( BSI ) scores were recorded at admission , at the end of treatment , and at 6- and 12-month follow-ups . RESULTS Thirty-two patients ( 48.5 % ) were classified as SE-AN ( i.e. , duration of illness > 7 years ) , and 34 ( 51.5 % ) as NSE-AN . During the treatment , both groups displayed similarly large increases in BMI , as well as improvements in eating-disorder and general psychopathology . After discharge minor deterioration did occur , but both NSE-AN and SE-AN groups showed similar rates of ' good BMI outcome ' ( BM ≥ 18.5 ; 44.0 % and 40.7 % , respectively ) and ' full response ' ( BMI ≥ 18.5 and minimal eating-disorder psychopathology ; 32.0 % and 33.3 % , respectively ) at 12-month follow-up . CONCLUSIONS These findings suggest that inpatient CBT-E is well accepted by patients with AN , and could also be a viable and promising treatment for those with SE-AN 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 OBJECTIVE Adolescents with Anorexia Nervosa ( AN ) , treated with family-based treatment ( FBT )  who fail to gain 2.3 kg by the fourth week of treatment have a 40 - 50 % lower chance of recovery than those who do . Because of the high risk of developing enduring AN , improving outcomes in this group of poor responders is essential . This study examines the feasibility and effects of a novel adaptive treatment ( i.e. , Intensive Parental Coaching-IPC ) aim ed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT . METHOD 45 adolescents ( 12 - 18 years of age ) meeting DSM TR IV criteria for AN were r and omized in an unbalanced design ( 10 to st and ard FBT ; 35 to the adaptive arm ) . Attrition , suitability , expectancy rates , weight change , and psychopathology were compared between groups . OUTCOMES There were no differences in rates of attrition , suitability , expectancy ratings , or most clinical outcomes between r and omized groups . However , the group of poor early responders that received IPC achieved full weight restoration ( > 95 % of expected mean BMI ) by EOT at similar rates as those who had responded early . CONCLUSIONS The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT . The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early . A sufficiently powered study is needed to confirm these promising findings 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 BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia OBJECTIVE To compare the effectiveness of behavioral family systems therapy ( BFST ) with that of ego-oriented individual therapy ( EOIT ) as treatments for adolescents with anorexia nervosa . METHOD Thirty-seven adolescents meeting DSM-III-R criteria for anorexia nervosa were r and omly assigned to receive BFST or EOIT , in addition to a common medical and dietary regimen . In BFST , the family was seen conjointly , the parents were placed in control of the adolescent 's eating , distorted beliefs were targeted through cognitive restructuring , and strategic/behavioral interventions were used to change family interactions . In EOIT , the adolescent was seen individually , with an emphasis on building ego strength and uncovering the dynamics blocking eating ; parents were seen collaterally . Measures administered before , after , and at 1-year follow-up tapped body mass index , menstruation , eating attitudes , ego functioning , depression , and family interactions . RESULTS BFST produced greater weight gain and higher rates of resumption of menstruation than EOIT . Both treatments produced comparably large improvements in eating attitudes , depression , and eating-related family conflict , but very few changes occurred on ego functioning . CONCLUSIONS BFST and EOIT proved to be effective treatments for adolescents with anorexia nervosa , but BFST produced a faster return to health OBJECTIVE There have been few r and omized clinical trials ( RCTs ) for adolescents with anorexia nervosa ( AN ) . Most of these posit that involving all family members in treatment supports favorable outcomes . However , at least 2 RCTs suggest that separate parent and adolescent sessions may be just as effective as conjoint treatment . This study compared the relative efficacy of family-based treatment ( FBT ) and parent-focused treatment ( PFT ) . In PFT , the therapist meets with the parents only , while a nurse monitors the patient . METHOD Participants ( N = 107 ) aged 12 to 18 years and meeting DSM 4(th)Edition criteria for AN or partial AN were r and omized to either FBT or PFT .  Participants were assessed at baseline , end of treatment ( EOT ) , and at 6 and 12 months posttreatment . Treatments comprised 18 outpatient sessions over 6 months . The primary outcome was remission , defined as ≥95 % of median body mass index and Eating Disorder Examination Global Score within 1 SD of community norms . RESULTS Remission was higher in PFT than in FBT at EOT ( 43 % versus 22 % ; p = .016 , odds ratio [ OR ] = 3.03 , 95 % CI = 1.23 - 7.46 ) , but did not differ statistically at 6-month ( PFT 39 % versus FBT 22 % ; p = .053 , OR = 2.48 , CI = 0.989 - 6.22 ) , or 12-month ( PFT 37 % versus FBT 29 % ; p = .444 , OR = 1.39 , 95 % CI = 0.60 - 3.21 ) follow-up . Several treatment effect moderators of primary outcome were identified . CONCLUSION At EOT , PFT was more efficacious than FBT in bringing about remission in adolescents with AN . However , differences in remission rates  between PFT and FBT at follow-up were not statistically significant . CLINICAL TRIAL REGISTRATION INFORMATION A R and omised Controlled Trial of Two Forms of Family-Based Treatment and the Effect on Percent Ideal Body Weight and Eating Disorders Symptoms in Adolescent Anorexia Nervosa ; http://www.anzctr.org.au/ ; ACTRN12610000216011 Background Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa , with a general consensus in the field that eating disorders focussed family therapy ( often referred to as Maudsley Family Therapy or Family Based Treatment ) currently offers the most promising outcomes . Nevertheless , a significant number do not respond well and additional treatment developments are needed to improve outcomes . Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first r and omised controlled trial of multifamily therapy for adolescent anorexia nervosa . Methods The study was a pragmatic multicentre r and omised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy ( MFT-AN ) and single family therapy ( FT-AN ) .  A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified ( restricting type ) were r and omised to the two treatments using computer generated blocks of r and om sizes to ensure balanced numbers in the trial arms . Independent assessors , blind to the allocation , completed evaluations at baseline , 3 months , 12 months ( end of treatment ) and 18 months . Results Both treatment groups showed clinical ly significant improvements with just under 60 % achieving a good or intermediate outcome ( on the Morgan-Russell scales ) at the end of treatment in the FT-AN group and more than 75 % in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention ( OR = 2.55 95 % ; CI 1.17 , 5.52 ; p = 0.019 ) . At follow-up ( 18 months post baseline ) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant . Clinical ly significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology . Approximately half the patients in FT-AN and nearly 60 % of those in MFT-AN had started menstruating . Conclusions This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family re sources and mutual support leading to improved outcomes .Trial Registration Current Controlled Trials IS RCT N11275465 ; Registered 29 January 2007 ( retrospectively registered Background : The aim of this study was to compare the immediate and longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa , one focused exclusively on the patients ' eating disorder features and the other focused also on mood intolerance , clinical perfectionism , core low self-esteem or interpersonal difficulties . Both programmes were derived from enhanced cognitive behaviour therapy ( CBT-E ) for eating disorders . Methods : Eighty consecutive patients with severe anorexia nervosa were r and omized to the two inpatient CBT-E programmes , both of which involved 20 weeks of treatment ( 13 weeks as an inpatient and 7 as a day patient ) . The patients were then followed up over 12 months . The assessment s were made blind to treatment condition . Results : Eighty-one percent of the eligible patients accepted inpatient CBT-E , of whom 90 % completed the 20 weeks of treatment . The patients in both programmes showed significant improvements in weight , eating disorder and general psychopathology . Deterioration after discharge did occur but it was not marked and it was restricted to the first 6 months . There were no statistically significant differences between the effects of the two programmes . Conclusions : These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a viable and promising treatment for severe anorexia nervosa . There appears to be no benefit from using the more complex form of the treatment 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 OBJECTIVE Research suggests that family treatment for adolescents with anorexia nervosa may be effective . This study was design ed to determine the optimal length of such family therapy . METHOD Eighty-six adolescents ( 12 - 18 years of age ) diagnosed with anorexia nervosa were allocated at r and om to either a short-term ( 10 sessions over 6 months ) or long-term treatment ( 20 sessions over 12 months ) and evaluated at the end of 1 year using the Eating Disorder Examination ( EDE ) between 1999 and 2002 . RESULTS Although adequately powered to detect differences between treatment groups , an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups . Although a nonsignificant finding does not prove the null hypothesis , in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level . However , post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment . CONCLUSIONS A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short- duration anorexia nervosa . However , there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment BACKGROUND There is evidence that specific psychological treatments are effective in patients with eating disorders . Our goal was to determine by means of a controlled trial whether psychological treatments , previously found to be effective in anorexia nervosa , gave rise to enduring benefits . METHODS A 5-year follow-up was conducted on patients who had participated in a previous trial of family therapy for anorexia and bulimia nervosa .  Family therapy or individual supportive therapy had been administered to 80 out patients for 1 year beginning on discharge from hospital after weight restoration . The 80 patients had been subdivided into 4 prognostically homogeneous groups of which 2 turned out to be the most important : patients with early onset and short history of anorexia nervosa , and patients with late-onset anorexia nervosa . At the 5-year follow-up , the efficacy of the outpatient therapies was again assessed by the maintenance of weight , and the categories of general outcome and dimensions of clinical functioning defined by the Morgan-Russell scales . RESULTS Significant improvements were found in the group of 80 patients as a whole , mainly attributable to the natural outcome of anorexia nervosa , and most evident in the early onset and short history group , as expected . Within 2 of the prognostic groups , significant benefits attributable to previous psychological treatments were still evident , favoring family therapy for patients with early onset and short history of anorexia nervosa and favoring individual supportive therapy for patients with late-onset anorexia nervosa . CONCLUSIONS Much of the improvements found at a 5-year follow-up can be attributed to the natural outcome of the illness . Nevertheless , it was still possible to detect long-term benefits of psychological therapies completed 5 years previously OBJECTIVE While pharmacological interventions are of established utility in bulimia nervosa , medications have no clear role in the treatment of anorexia nervosa . Because patients with anorexia nervosa frequently exhibit mood disturbances and symptoms of obsessive-compulsive disorder , the authors tested the utility of fluoxetine in the treatment of women participating in an inpatient program for anorexia nervosa . METHOD The authors conducted a r and omized , placebo-controlled , double-blind , 7-week study of fluoxetine at a target daily dose of 60 mg in 31 women with anorexia nervosa receiving treatment for their eating disorder on a clinical research unit .  Body weight and measures of eating behavior and psychological state were obtained at baseline and at termination . RESULTS There were no significant differences in clinical outcome on any measure between patients receiving fluoxetine and patients receiving placebo . CONCLUSIONS Fluoxetine does not appear to add significant benefit to the inpatient treatment of anorexia nervosa Research on treatments in anorexia nervosa ( AN ) is scarce . Although most of the therapeutic programs used in ‘ real world practice ’ in AN treatment resort to multidisciplinary approaches , they have rarely been evaluated . Objective To compare two multidimensional post-hospitalization out patients treatment programs for adolescents with severe AN :  Treatment as Usual ( TAU ) versus this treatment plus family therapy ( TAU+FT ) . Method Sixty female AN adolescents , aged 13 to 19 years , were included in a r and omized parallel controlled trial conducted from 1999 to 2002 for the recruitment , and until 2004 for the 18 months follow-up . Allocation to one of the two treatment groups ( 30 in each arm ) was r and omised . The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents . The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics , but not eating disorder symptoms . The main Outcome Measure was the Morgan and Russell outcome category ( Good or Intermediate versus Poor outcome ) . Secondary outcome indicators included AN symptoms or their consequences ( eating symptoms , body mass index , amenorrhea , number of hospitalizations in the course of follow-up , social adjustment ) . The evaluators , but not participants , were blind to r and omization . Results At 18 months follow-up , we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy ( Intention-to-treat : TAU+FT : 12/30 ( 40 % ) ; TAU : 5/29 ( 17.2 % ) p = 0.05 ; Per Protocol analysis : respectively 12/26 ( 46.2 % ) ; 4/27 ( 14.8 % ) , p = 0.01 ) . Similar group effects were observed in terms of achievement of a healthy weight ( i.e. , BMI ≥10th percentile ) and menstrual status . Conclusions Adding family therapy sessions , focusing on intra-familial dynamics rather than eating symptomatology , to a multidimensional program improves treatment effectiveness in girls with severe AN . Trial Registration Controlled-trials.com IS RCT Anorexia nervosa is difficult to treat and no treatment is supported by robust evidence . As it is uncommon , it has been recommended that new treatments should undergo extensive preliminary testing before being evaluated in r and omized controlled trials . The aim of the present study was to establish the immediate and longer-term outcome following “ enhanced ” cognitive behaviour therapy ( CBT-E ) .  Ninety-nine adult patients with marked anorexia nervosa ( body mass index ≤ 17.5 ) were recruited from consecutive referrals to clinics in the UK and Italy . Each was offered 40 sessions of CBT-E over 40 weeks with no concurrent treatment . Sixty-four percent of the patients were able to complete this outpatient treatment and in these patients there was a substantial increase in weight ( 7.47 kg , SD 4.93 ) and BMI ( 2.77 , SD 1.81 ) . Eating disorder features also improved markedly . Over the 60-week follow-up period there was little deterioration despite minimal additional treatment . These findings provide strong preliminary support for this use of CBT-E and justify its further evaluation in r and omized controlled trials . As CBT-E has already been established as a treatment for bulimia nervosa and eating disorder not otherwise specified , the findings also confirm that CBT-E is transdiagnostic in its scope
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 ) .