Basic HTML Version
EDRS 2012
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21
COMPARISON OF INPATIENT AND DAY-PATIENT
TREATMENT IN NON-CHRONIC ADOLESCENT
ANOREXIA NERVOSA (AN) – RESULTS OF A LARGE
MULTI-CENTRE RANDOMIZED STUDY IN GERMANY
Beate Herpertz-Dahlmann
1
, Katharina Bühren
1
, Andreas
Warnke
2
, Ernst Pfeiffer
3
, Christian Fleischhaker
4
, Christoph
Wewetzer
5
, Reinhild Schwarte
1
1
Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, RWTH Aachen
University, Aachen, Germany,
2
Department of Child and
Adolescent Psychiatry, Psychosomatics and Psychotherapy,
University Hospital, Würzburg, Germany,
3
Department of
Child and Adolescent Psychiatry, Psychosomatics and
Psychotherapy, Charite University Hospital, Berlin, Germany,
4
Division of Child and Adolescent Psychiatry, Albert Ludwig
University Medical Center, Freiburg, Germany,
5
Department
of Child and Adolescent Psychiatry, Köln-Holweide, Germany
1. Introduction: Although inpatient treatment (IP) is considered
the treatment of choice for severely undernourished patients
with AN, recent studies have challenged this opinion.
However, only very few studies on day patient (DP) treatment
with small sample sizes exist. We hypothesized that DP
was not inferior to IP after 1-year follow-up. 2. Methods: We
performed a randomized controlled multi-centre study at
different sites in Germany including university and community
hospitals comparing IP and DP treatment in 11 to 18 year-old
AN patients. Inclusion criteria were a DSM-IV diagnosis of
AN, female sex and first onset of AN. Patients received an
identical treatment program on IP or DP basis. 3. Results:
N=660 patients were assessed for eligibility, 275 approached
to participate, n= 180 agreed, 87 were randomized to IP, n=89
to DP. 90.4% of the IP and 97.1 % of the DP sample took
part in the 52
nd
week follow-up. On an Intention to treat basis
there was no significant difference in weight gain between
IP and DP (non-inferiority analysis). A similar result was
obtained in the per protocol analysis. Superiority of DP just
missed significance. The average outcome score by Morgan
& Russell tended to be better in the DP group. 4. Conclusion:
DP seems to be as helpful as IP in non-chronic adolescent
AN. Drop-out of study and amount of costs was significantly
less in DP.
22
PSYCHOLOCIAL PREDICTORS OF OUTCOME
FOLLOWING BARIATRIC SURGERY
Susan M Byrne, Michael Davis, Jeffery Hamdorf
University of Western Australia, Perth, Australia
Introduction:
The number of bariatric surgeries performed
worldwide has increased dramatically in recent years. This
reflects both the increased prevalence of severe obesity and
the impressive weight loss achieved through bariatric surgery.
The most common bariatric surgery procedure performed in
Australia is laporoscopic adjustable gastric banding (LAGB).
This procedure commonly results in successful weight loss (≥
50% excess body weight), however, a significant minority of
individuals (up to 25%) fail to achieve a successful outcome.
No consistently reproducible predictors of outcome following
LAGB have been identified.
Method:
This study aimed to
identify pre-operative psychological predictors of weight
loss in 152 patients who received LAGB. Before undergoing
surgery, patients attended a clinical interview and completed
a battery of self-report questionnaires assessing a range of
psychosocial factors. Weight loss was measured up to 24
months post-surgery.
Results:
Results indicated that weight
loss following LAGB was influenced by two broad factors:
(i) general psychological well-being (depression, anxiety,
stress and self-esteem) and (ii) tolerance of, and response
to, negative mood states (mood intolerance and emotional
eating).
Conclusions:
These factors should be assessed
pre-operatively in LAGB patients. Those reporting poor
psychological well-being and/or a tendency to eat in order
to moderate negative mood states may benefit from adjunct
psychological treatment.
23
BINGE-PURGE ANOREXICS ENGAGE IN MORE
RESTRICTION THAN RESTRICTING ANOREXICS
Ross D Crosby
1,2
, Kristine J Steffen
1,2
, Stephen A
Wonderlich
1,2
, Scott G Engel
1,2
, Scott J Crow
3
, Carol B
Peterson
3
, Daniel Le Grange
4
, James E Mitchell
1,2
1
Neuropsychiatric Research Institute, Fargo, ND, USA,
2
University of North Dakota School of Medicine and Health
Sciences, Fargo, ND, USA,
3
University of Minnesota,
Minneapolis, MN, USA,
4
University of Chicago, Chicago, IL,
USA
Introduction:
DSM-IV identifies two subtypes of AN:
a restricting subtype (AN-R) characterized by dietary
restriction, fasting and excessive exercise, and a binge-
eating/purging subtype (AN-BP) characterized by binge
eating and/or purging. No studies to date have compared
the behavior of AN subtypes in the natural environment. The
purpose of the current study is to compare AN-subtypes
on eating-related behaviors using ecological momentary
assessment.
Methods:
A total of 118 adult females meeting
full or sub-threshold DSM-IV criteria for AN were interviewed
with the SCID and EDE. Participants were then provided
with handheld computers and asked to report mood and
eating-related behaviors over a two-week period.
Results:
Participants provided 15, 051 separate EMA recordings
representing 1,767 separate participant days. As expected,
AN-BP was associated with higher rates of binge eating
and purging. The AN-BP and AN-R subtypes did not differ in
the frequency of exercise. However, AN-BP reported higher
rates of body checking, skipping meals, eating as little as
possible, not eating for 8 hours, and limiting intake to 1200
calories. AN-R was more likely to report limiting fat intake
and carbohydrates.
Conclusions:
AN-BP reported engaging
more in a variety of eating disordered behaviors, including
those related to dietary restriction. These findings support the
diagnostic distinction between AN subtypes, but suggest that
dietary restriction does not uniquely characterize AN-R.
24
Impulse control, executive functioning and
decision-making in extremely obese individuals
with and without regular binge eating
Astrid Müller
1
, Christina Brandl
2
, Ekaterini Georgiadou
1
,
Wibke Kiunke
3
, Martina de Zwaan
1
1
Department of Psychosomatic Medicine and Psychotherapy,
Hannover Medical School, Hannover, Germany,
2
Department
of Psychosomatic Medicine and Psychotherapy, University of
Erlangen-Nuremberg, Erlangen, Germany,
3
Schön Clinic Bad
Bramstedt, Bad Bramstedt, Germany
(belongs to the symposion: IMPULSIVITY IN EXTREME
WEIGHT CONDITIONS; Laurence Claes) Objective:
Previous research suggests impaired cognitive functioning
and impaired decision-making in obese individuals. The
aim of the present study was to compare impulse control,
executive function, and decision-making in morbidly obese
patients with and without regular binge eating. Methods:
Hundred-thirty prebariatric surgery patients with obesity grade
II or III answered several questionnaires (e.g., EDE-Q, BIS/
BAS scales, ATQ-Effortful Control subscale, Connors Scale,
PHQ-9) and underwent computerized neurocognitive testing
including Iowa Gambling Task, Stroop Task, Labyrinth-Task,
Trail Making Task B, and Tower of Hanoi. Results: Thirty
percent of the total sample reported regular binge eating.
They did not differ significantly from those without binge
eating with respect to BMI, age, gender, and education but
reported more pathological scores with regard to eating
disorder and depressive symptoms, impulsivity, and effortful
control. Furthermore, individuals with binge eating performed
worse on the Iowa Gambling task compared to those without
binge eating. No significant group differences emerged
with regard to the other neurocognitive tests. Conclusion:
Data suggest that regular binge eating in morbidly obese
individuals is associated with impaired impulse control and
reduced ability to delay gratification that may influence food
intake.
PLENARY/ORAL ABSTRACTS