22
EDRS 2013
PARALLEL PAPER SESSION
Friday, 1:30 - 2:45 PM
Lalique
Treatment/Prevention
31
GUIDED SELF HELP CBT TREATMENT FOR BULIMIC DISORDERS:
EFFECTIVENESS, CLINICAL SIGNIFICANT CHANGE, AND EARLY
CHANGE
Paulo PP Machado, Ana Rita Vaz, Eva Conceição
University of Minho, BRAGA, Portugal
The aim of this study was to test the effectiveness of a cognitive-
behavioral guided self-help treatment program for Bulimia Nervosa and
similar disorders. Participants were assessed at the beginning, end-of-
treatment, and at 6-months follow-up, using the EDE-Q, OQ-45, and the
BDI. Forty-two participants from an eating disorders treatment service
participated in this study. This study followed a one group repeated
measures naturalistic design with no control group. To measure group
change, data were analysed using HLM for testing differences across the
three time assessment points. To measure individual change, the criterion
of clinical significance of Jacobson and Truax (1991) was applied. Results
showed a significant reduction in EDE scores, OQ-45 and BDI. Clinically
significant change occurred for the majority of participants. Additionally,
Survival Analyses were performed to estimate the proportion of patients
that attained a 51% reduction in bulimic symptoms. Logistic regression
was used to find the predictive value of early response and other variables
in binge remission at post treatment. Results showed that the mean time
to achieve a 51% reduction in binge was 3.60 sessions and 3.96 sessions
for purging behavior. Early change occurred in session 3 for at least 50%
of the participants in this study. Early change was the most significant
predictor of binge remission, binge frequency at post treatment and eating
psychopathology at post treatment.
32
rTMS OF THE DORSOMEDIAL PREFRONTAL CORTEX FOR BINGE
AND PURGE BEHAVIOURS IN REFRACTORY ANOREXIA AND
BULIMIA NERVOSA: A CASE SERIES
Jonathan Downar
1,2
,
Katharine Dunlop
1
,
Joseph Geraci
2
,
Nathan Bakker
1
,
Tim Salomons
2
,
Peter Giacobbe
1,2
,
Marion Olmsted
1,2
,
Patricia Colton
1,2
,
Blake Woodside
1,2
1
University of Toronto, Toronto, ON, Canada,
2
University Health Network,
Toronto, ON, Canada
Introduction
:
rTMS is currently being explored as a potential adjunctive
treatment for anorexia and bulimia nervosa. Previous studies have found,
at best, modest efficacy for rTMS in this setting using the conventional
target in the dorsolateral prefrontal cortex (DLPFC). However,
neuroimaging studies suggest that the dorsomedial prefrontal cortex
(
DMPFC) may be more central to inhibiting binge and purge episodes.
Methods
: 24
patients with either anorexia or bulimia nervosa and bingeing
and purging behaviours refractory to medications and therapy underwent
MRI-guided rTMS of the DMPFC using 10 Hz stimulation, 120% resting
motor threshold, bilateral, 3000 pulses per hemisphere, 20 sessions over
4
weeks.
Results
:
binge frequency improved from 19.5 to 13.9 episodes/
week and purge frequency improved from 27.0 to 17.3 episodes/week.
Baseline frequencies were quite variable among patients, however; in
relative terms, binge frequency improved 55.1% and purge frequency
improved 44.4%. Response was strongly bimodal. 25% of patients
achieved 90-100% reduction in symptom frequency. Pre-treatment
resting-state fMRI identified low functional connectivity from the subgenual
cingulate cortex to the dorsal raphe nuclei and right amygdala and anterior
hippocampus as a predictor of good response to treatment.
Conclusions
:
rTMS of the DMPFC may represent an effective adjunct to conventional
treatment for binge-purge behaviours. A randomized controlled trial of this
approach may be warranted.
33
FACEBOOK AND THE EFFECTS OF A MEDIA LITERACY
INTERVENTION ON BODY DISSATISFACTION
Anna M. Bardone-Cone, Anna M. Karam
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Social media provides a forum for presenting favorably and facilitating
social comparison. We examined whether a media literacy intervention
would buffer negative effects of Facebook on body image. Participants
were college students (175 females, 165 males) randomized to
intervention condition (media literacy about idealized presentations on
Facebook vs. control involving Facebook statistics) and Facebook viewing
instructions (directed to view attractive peers - upward social comparison
vs. usual viewing). Dependent variables were indices of body image.
Women were much more likely to at least often compare themselves
to images of same-sex peers on Facebook (44%) than men (11%).
Intervention condition x Facebook viewing did not predict body image
for women, but there was a trend for this interaction predicting muscle
dissatisfaction in men. Interestingly, men who viewed attractive same-
sex peers and who were in the media literacy condition has the lowest
level of muscle satisfaction. When perfectionistic self-presentation was
considered as a moderator, a significant 3-way interaction emerged; the
need to present as perfect was most pernicious for men viewing attractive
peers and receiving the message that individuals present their best selves
on Facebook. More research is needed on Facebook effects on body
image, but results suggest that interventions intended to minimize body
dissatisfaction may instead make comparisons with the body more salient,
at least for men.
34
LONG TERM EFFECTIVENESS OF RESIDENTIAL EATING DISORDER
TREATMENT
Jillian G. Lampert
1,2
,
Scott J. Crow
1,2
,
Ross D. Crosby
3
,
Mary Jo Kreitzer
2
,
Catherine L. Cronemeyer
4
1
The Emily Program, St. Paul, MN, USA,
2
University of Minnesota,
Minneapolis, MN, USA,
3
Neuropsychiatric Research Institute, Fargo, ND,
USA,
4
Park Nicollet Melrose Institute, Minneapolis, MN, USA
Introduction.
Data on the effectiveness of residential eating disorder
treatment are limited. This study examined long term effectiveness of a
comprehensive residential eating disorder program treating adults with
anorexia nervosa, bulimia nervosa, and eating disorder not otherwise
specified.
Methods
.
Fifty-five consecutive adult female residential patients
were enrolled and assessed at admission, discharge, and at 3, 6, 9, 12,
15, 18, 21, 24, 27,
and 30 months post treatment. An age, dx, and BMI
matched comparison group was assessed at 30 months post inpatient
treatment. Outcome measures were Body Mass Index (BMI), Eating
Disorder Examination-Questionnaire (EDEQ), Eating Disorder Inventory
(
EDI), Rosenberg Self-Esteem Scale (RSE), Short Form Health Survey
(
SF-36) assessed at residential admission and 30 month follow-up for both
groups. McKnight Follow-Up of Eating Disorders (MFED) assessed care
utilization across the follow-up period. Mixed-effects general linear models
were used to compare changes in eating disorder psychopathology, self-
esteem, and quality of life between admission and follow-up and between
groups. A GEE model appropriate for count data was used to compare
care utilization during the follow up period between groups.
Results.
From
admission to 30 month follow-up, eating disorder psychopathology, self-
esteem, and quality of life significantly improved. All EDE-Q and SF-36
subscales showed significant improvement (p<0.001; p=0.007 to p<0.001)
as well as numerous EDI-3 subscales(p=0.009 to p=0.017). Mean BMI
was in the normal range for all diagnoses. Results were similar between
residential and comparison groups at follow-up. In terms of care utilization,
residents used significantly fewer inpatient and partial days and medical
and therapy services during the follow-up period than the comparison
group.
Conclusions
.
Residential treatment demonstrated long-term
effectiveness and differential care utilization over 2.5 year follow-up
indicating viability as a cost-effective treatment option.
35
DEEP BRAIN STIMULATION FOR TREATMENT-REFRACTORY
ANOREXIA NERVOSA: CLINICAL AND IMAGING FOLLOW-UP AT
ONE-YEAR
Nir Lipsman
1
,
Andres Lozano
1
,
Blake Woodside
2
1
University Health Network, Toronto Western Hospital, Division of
Neurosurgery, Toronto, ON, Canada,
2
University Health Network, Toronto
General Hospital, Department of Psychiatry, Toronto, ON, Canada
Purpose
Novel therapeutic approaches for treatment-refractory anorexia
nervosa (TR-AN) are urgently needed. Deep Brain Stimulation (DBS), a
surgical procedure that modulates activity in dysfunctional neural circuits,
was shown to be safe in TR-AN in a phase I trial. Here we describe clinical
and imaging outcomes at 1-year following DBS for TR-AN.
Methods
Seven patients (mean age: 35.9y; illness duration: 16.6y) received
subcallosal cingulate DBS for TR-AN. Patients were referred from two
large eating disorders clinics, and required an independent evaluation
for trial eligibility. Enrolled patients underwent baseline psychometrics
and neuroimaging, which were repeated after 1, 3, 6 and 12 months of
open-label stimulation.
Results
All patients tolerated the procedure well,
with 1 serious adverse event. At one-year, 4 patients saw improvements
in BMI compared to baseline, and 6 patients completed for the first time
an elective admission for intensive treatment. DBS was associated with
significant changes in mood and anxiety, including an average 52%
and 50% reduction in Hamilton Depression and Yale-Brown Obsessive
Compulsive scores, respectively. FDG-PET showed changes in cerebral
glucose metabolism with DBS in key AN-related structures.
Conclusion
DBS appears to be safe in TR-AN, and was associated with improvements
in mood, anxiety and affective regulation. These changes may serve to
enhance currently available therapies and help convert non-responding
patients to responders.
ORAL ABSTRACTS
