scholarly journals A multicenter audit of outpatient care for adult anorexia nervosa: Symptom trajectory, service use, and evidence in support of “early stage” versus “severe and enduring” classification

2020 ◽  
Vol 53 (8) ◽  
pp. 1337-1348 ◽  
Author(s):  
Suman Ambwani ◽  
Valentina Cardi ◽  
Gaia Albano ◽  
Li Cao ◽  
Ross D. Crosby ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Outpatient Care ◽  
Service Use ◽  
Early Stage ◽  
Stage Versus ◽  
Symptom Trajectory

scholarly journals Prognostic effect of sidedness in early stage versus advanced colon cancer

2018 ◽  
Vol 1 (8) ◽  
pp. e54 ◽  
Author(s):  
H.F. Kennecke ◽  
Y. Yin ◽  
J.M. Davies ◽  
C.H. Speers ◽  
W.Y. Cheung ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Early Stage ◽  
Stage Versus ◽  
Prognostic Effect ◽  
Advanced Colon Cancer

scholarly journals Differences in Patterns of Recurrence in Early-Stage Versus Locally Advanced Non-Small Cell Lung Cancer

2014 ◽  
Vol 98 (5) ◽  
pp. 1755-1761 ◽  
Author(s):  
Feiran Lou ◽  
Camelia S. Sima ◽  
Valerie W. Rusch ◽  
David R. Jones ◽  
James Huang
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Small Cell ◽  
Stage Versus ◽  
Small Cell Lung ◽  
Patterns Of Recurrence

The health service use and cost of eating disorders

2005 ◽  
Vol 35 (11) ◽  
pp. 1543-1551 ◽  
Author(s):  
JUDIT SIMON ◽  
ULRIKE SCHMIDT ◽  
STEPHEN PILLING
Keyword(s):  
Health Care ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Resource Use ◽  
Service Use ◽  
Health Care Cost ◽  
Health Service Use ◽  
The Uk ◽  
Care Costs ◽  
Cost Of Illness Studies

Background. The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders.Method. Relevant literature (1980–2002) was identified from searches of electronic databases and expert contacts.Results. Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be £4·2 million in 1990. In Germany, the health care cost was €65 million for anorexia nervosa and €10 million for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus$22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs.Conclusions. The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.

Summary Australian and New Zealand Clinical Practice Guideline for the Management of Anorexia Nervosa(2003)

2003 ◽  
Vol 11 (2) ◽  
pp. 129-133 ◽  
Author(s):  
Pierre Beumont ◽  
Phillipa Hay ◽  
Rochelle Beumont ◽  
Keyword(s):  
Anorexia Nervosa ◽  
Clinical Practice ◽  
New Zealand ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Early Stage ◽  
General Medicine ◽  
Multidisciplinary Care ◽  
High Rate ◽  
Clinical Psychologist

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Anorexia Nervosa (AN). Conclusions: Anorexia nervosa affects only a small proportion of the Australian and New Zealand population but it is important because it is a serious and potentially life-threatening illness. Sufferers often struggle with AN for many years, if not for life, and the damage done to their minds and bodies may be irreversible. Anorexia nervosa is characterized by a deliberate loss of weight and refusal to eat. Overactivity is common. Approximately 50% of patients also use unhealthy purging and vomiting behaviours to lose weight. There are two main areas of physical interest: the undernutrition and mal-nutrition of the illness and the various detrimental weight-losing behaviours themselves. Basic psychopathology ranges from an over-valued idea of high salience concerning body shape through to total preoccupation and eventually to firmly held ideas that resemble delusions. Comorbid features are frequent, especially depression and obsessionality. It is inadvisable in clinical practice to apply too strict a definition of AN because to do so excludes patients in the early stage of the illness in whom prompt intervention is most likely to be effective. The best treatment appears to be multidimensional/multidisciplinary care, using a range of settings as required. Obviously, the medical manifestations of the illness need to be addressed and any physical harm halted and reversed. It is difficult to draw conclusions about the efficacy of further treatments. There is a paucity of clinical trials, and their quality is poor. Furthermore, the stimuli for developing AN are varied, and the psychotherapy options to address these problems need to be tailored to suit the individual patient. Because there is no known ‘chemical imbalance’ that causes the illness, no one drug offers relief. There is a high rate of relapse, and some patients are unable to recover fully. Because AN is a psychiatric illness, a psychiatrist should always be involved in its treatment. All psychiatrists should be capable of assuming this responsibility. Because cognitive behavioural methods are generally accepted as the best mode of therapy, a clinical psychologist should also be involved in treatment. Because medical manifestations are important, someone competent in general medicine should always be consulted. The optimal approach is multidisciplinary or at least multiskilled, with important contributions from psychologists, general practitioners, psychiatric nurses, paediatricians, dietitians and social workers.

scholarly journals The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Anca Sfärlea ◽  
Linda Lukas ◽  
Gerd Schulte-Körne ◽  
Belinda Platt
Keyword(s):  
Anorexia Nervosa ◽  
Information Processing ◽  
Eating Disorder ◽  
Cognitive Biases ◽  
Early Stage ◽  
Control Group ◽  
Memory Biases ◽  
Interpretation Biases ◽  
Clinical Control ◽  
Types Of Information

Abstract Background Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). Methods The present study systematically assesses cognitive biases in 12–18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. Discussion This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.

Who am I without anorexia? Identity exploration in the treatment of early stage anorexia nervosa during emerging adulthood: a case study

2019 ◽  
Vol 12 ◽  
Author(s):  
A. Koskina ◽  
U. Schmidt
Keyword(s):  
Anorexia Nervosa ◽  
Emerging Adulthood ◽  
Role Models ◽  
Early Stage ◽  
Significant Risk ◽  
List Type ◽  
Developmental Phase ◽  
Identity Exploration ◽  
Exploration And Development

Abstract Emerging adulthood (age 18–25 years) is a distinct developmental phase, characterized by multiple life changes, transitions and uncertainties, associated with significant risk of mental ill health in vulnerable individuals. Identity exploration and development is key during this phase, and the development of an eating disorder during this time can significantly impact on this process. This single-case study details the treatment of an 18-year-old female outpatient with first episode, recent onset anorexia nervosa. Using the Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA), focus was placed on identity exploration and development as a tool to reduce the dominance of anorexia nervosa and increase recovery focus. Outcome measures at end of treatment and 6-month follow-up showed significant sustained improvement in BMI and EDE-Q scores. The patient gave detailed positive feedback suggesting that this was a highly acceptable and effective intervention. The case study is discussed with reference to limitations and some reflections on the utility of incorporating identity work in the treatment of anorexia nervosa in emerging adulthood. Key learning aims (1) This case study is thought to have important clinical implications for tailoring the treatment of early stage AN to the emerging adult population. (2) Identity exploration is a key feature of this developmental stage, and incorporating this work into therapy allows for experimentation and formation of an alternative, healthy set of values, beliefs and behaviours. (3) This case also highlights the value of using role models in the construction of a non-illness driven identity, to support with behavioural change.

scholarly journals Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Sarah Byford ◽  
Hristina Petkova ◽  
Barbara Barrett ◽  
Tamsin Ford ◽  
Dasha Nicholls ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Cost Effectiveness ◽  
Children And Adolescents ◽  
Service Use ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Surveillance Study ◽  
Community Based

Abstract Background Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. Method Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children’s Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. Results Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. Conclusions Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. Trial registration ISRCTN12676087. Date of registration 07/01/2014.

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