Lisa Wong1,2, Lee Gan Goh3, Rajeev Ramachandran4,5. 1. Khoo Teck Puat - National University Children's Medical Institute, National University Health System, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore. 2. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 3. Department of Family Medicine, National University Health System & Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. Khoo Teck Puat - National University Children's Medical Institute, National University Health System, NUHS Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228, Singapore. rajeev_ramachandran@nuhs.edu.sg. 5. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. rajeev_ramachandran@nuhs.edu.sg.
Abstract
PURPOSE: To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia. METHODS: This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119). The patients either received manualised FBT (n = 42) or individualized adolescent focussed therapy (non-FBT) (n = 77). Patient characteristics and time to remission were abstracted from patient records. Survival analysis was used to determine median time to remission and remission-free survival rates. Hazard ratios for remission were obtained by cox regression. RESULTS: Patients in the non-FBT group had a significantly longer time to remission compared with the FBT group after adjustment for age, gender, BMI, psychiatric comorbidity, and ethnicity (p = 0.003, HR = 2.523, 95% CI 1.37-4.64). In the FBT group, the median time to remission was 5.0 months (95% CI 3.4-6.6 months); 11 months shorter than the non-FBT group (p < 0.001, 95% CI 7.9-14.1 months). FBT group remission rates were 69% and 90% at 1 and 2 years, respectively. Non-FBT group remission rates were 30% and 57% at 1 and 2 years, respectively. CONCLUSIONS: This study confirms that FBT is an effective treatment strategy for AN in adolescents in the Asian context. FBT can shorten the illness duration, which reduces disruption to schooling and family life at this critical life stage. LEVEL OF EVIDENCE: Level IV, evidence obtained from retrospective review of data before and after the introduction of new intervention.
PURPOSE: To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia. METHODS: This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119). The patients either received manualised FBT (n = 42) or individualized adolescent focussed therapy (non-FBT) (n = 77). Patient characteristics and time to remission were abstracted from patient records. Survival analysis was used to determine median time to remission and remission-free survival rates. Hazard ratios for remission were obtained by cox regression. RESULTS:Patients in the non-FBT group had a significantly longer time to remission compared with the FBT group after adjustment for age, gender, BMI, psychiatric comorbidity, and ethnicity (p = 0.003, HR = 2.523, 95% CI 1.37-4.64). In the FBT group, the median time to remission was 5.0 months (95% CI 3.4-6.6 months); 11 months shorter than the non-FBT group (p < 0.001, 95% CI 7.9-14.1 months). FBT group remission rates were 69% and 90% at 1 and 2 years, respectively. Non-FBT group remission rates were 30% and 57% at 1 and 2 years, respectively. CONCLUSIONS: This study confirms that FBT is an effective treatment strategy for AN in adolescents in the Asian context. FBT can shorten the illness duration, which reduces disruption to schooling and family life at this critical life stage. LEVEL OF EVIDENCE: Level IV, evidence obtained from retrospective review of data before and after the introduction of new intervention.
Authors: W Stewart Agras; James Lock; Harry Brandt; Susan W Bryson; Elizabeth Dodge; Katherine A Halmi; Booil Jo; Craig Johnson; Walter Kaye; Denise Wilfley; Blake Woodside Journal: JAMA Psychiatry Date: 2014-11 Impact factor: 21.596