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 randomised 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 (randomised 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.
RCT Entities:
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 randomised 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 (randomised or after out-patient transfer) predicted poor outcomes. CONCLUSIONS: First-line in-patientpsychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.
Authors: Lisa Brownstone; Kristen Anderson; Judy Beenhakker; James Lock; Daniel Le Grange Journal: Int J Eat Disord Date: 2012-03-12 Impact factor: 4.861
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Authors: Leslie K Anderson; Erin E Reilly; Laura Berner; Christina E Wierenga; Michelle D Jones; Tiffany A Brown; Walter H Kaye; Anne Cusack Journal: Curr Psychiatry Rep Date: 2017-08 Impact factor: 5.285
Authors: Daniel Le Grange; James Lock; Erin C Accurso; W Stewart Agras; Alison Darcy; Sarah Forsberg; Susan W Bryson Journal: J Am Acad Child Adolesc Psychiatry Date: 2014-08-23 Impact factor: 8.829
Authors: Sasha Shepperd; Helen Doll; Simon Gowers; Anthony James; Mina Fazel; Ray Fitzpatrick; Jon Pollock Journal: Cochrane Database Syst Rev Date: 2009-04-15