Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: A feasibility study

Background: Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN. Methods: A sample of 20 in- and outpatients (13–18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a “CRT Resource Pack.” Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences. Results: Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment. Conclusions: The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial. © The Author(s) 2013. Published by SAGE Publications

Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years

Background: A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. Method: A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. Results: We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, “continuous improvement” (54.8%); (b) a high symptom level at baseline and moderate decrease over time, “high and declining” (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, “consistently low” (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, “high and increasing” (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome Discussion: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. Public Significance: Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care

Associations of changes in physical activity and sedentary time with weight recurrence after bariatric surgery: a 5-year prospective study

Background Increasing physical activity and limiting sedentary time may minimize weight recurrence after bariatric surgery. However, few studies have evaluated potential associations of objectively-measured physical activity and sedentary time with post-surgical weight recurrence over time. Aims To evaluate associations of change in physical activity and sedentary time with weight recurrence after bariatric surgery. Methods Participants from the Oslo Bariatric Surgery Study, a prospective cohort study, wore an ActiGraph monitor for seven days at 1- and 5 years after surgery to assess daily physical activity and sedentary time. Participants’ weight was measured at in-person clinic visits. Chi-square Test and Paired-samples T-test evaluated group differences and change over time, while Pearson’s Correlation, multiple logistic and linear regression investigated associations between variables. Results Five years after surgery 79 participants (70.5% response rate, 81% female) (mean (sd) age: 54.0 (±9.3), BMI: 32.1 (±4.7)) had valid monitor data. Participants increased their sedentary time (71.4 minutes/day (95% CI: 54.2–88.6, p = <0.001)) and reduced daily steps (−1411.1 (95% CI: 737.8–208.4), p = <0.001), light physical activity (−54.1 min/day (95% CI: 40.9–67.2, p = <0.001)), and total physical activity (−48.2 (95% CI: 34.6–63.3), p = <0.001) from 1- to 5 years after surgery. No change was found for moderate-to-vigorous intensity physical activity. No associations were found between changes in steps, physical activity or sedentary time and weight recurrence. Conclusion Participants increased sedentary time and decreased light- and total physical activity between 1- and 5 years post-surgery. Overall, changes in physical activity and sedentary time were not associated with weight recurrence. Interventions to help patients increase physical activity and limit sedentary time after bariatric surgery are needed.publishedVersio

Reduced risk of hospitalisation among reported COVID-19 cases infected with the SARS-CoV-2 Omicron BA.1 variant compared with the Delta variant, Norway, December 2021 to January 2022

We included 39,524 COVID-19 Omicron and 51,481 Delta cases reported in Norway from December 2021 to January 2022. We estimated a 73% reduced risk of hospitalisation (adjusted hazard ratio: 0.27; 95% confidence interval: 0.20–0.36) for Omicron compared with Delta. Compared with unvaccinated groups, Omicron cases who had completed primary two-dose vaccination 7–179 days before diagnosis had a lower reduced risk than Delta (66% vs 93%). People vaccinated with three doses had a similar risk reduction (86% vs 88%).publishedVersio

A systematic review of cognitive remediation therapy for anorexia nervosa - Development, current state and implications for future research and clinical practice

Objective: To systematically review studies of cognitive remediation therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research. Method: The literature was reviewed using the PubMed, Web of Science and PsycINFO search terms “cognitive remediation therapy” AND “anorexia nervosa”. Papers published online between 2005 and 2013 were selected on the basis of three inclusion criteria: 1) studies of any design focusing on CRT for AN, 2) papers that were written in English or had an available published English translation, and 3) papers published in peer reviewed journals. Results: A total of 45 papers were identified of which 21 were recognized as being relevant for the review. Relevant papers were divided into three different categories 1) single case reports, 2) case series and 3) randomised controlled trials (RCTs). Single case studies and case series yielded strong evidence of feasibility and acceptability of CRT for AN despite great variety in sample compositions. Four RCTs demonstrate that CRT has the potential of enhancing the effectiveness of current treatments, reduce attrition, increase cognitive set-shifting abilities and quality of life, as well as reduce eating disorder psychopathology. Discussion: The number of CRT studies published is growing rapidly, in particular RCTs. Further research is needed to define the primary aim of delivering CRT to patients with eating disorders, and to establish how to best measure the effect of the intervention. Moreover, researchers and clinicians should focus on identifying and assessing specific versus non-specific CRT contributions, and explore long-term effects of the intervention. It is imperative that adolescent RCTs are conducted to evaluate how CRT may be effective as a treatment for this young patient group

User satisfaction with family-based inpatient treatment for adolescent anorexia nervosa: retrospective views of patients and parents

Background Research is scarce on patient and parent satisfaction with family-based treatment for adolescent anorexia nervosa (AN), especially family-based treatment adapted to inpatient settings. The purpose of this study was to describe and compare patient and parent satisfaction with an inpatient family-based treatment program for adolescent AN, and to investigate whether the level of satisfaction with treatment was associated with eating disorder outcome. Methods Former patients and their parents were contacted approximately five years (4.5 ± 1.7, range: 1.3–7.0) after discharge from family-based inpatient treatment. Ninety-four participants (patients: n = 34, mothers: n = 40, fathers: n = 20) from 46/58 (79.3%) families took part in the study. Former patients and both parents completed treatment satisfaction questionnaires. Outcome at follow-up was assessed by the Eating Disorder Examination Questionnaire and body mass index (kg/m2). Results Overall, mothers and fathers reported a high level of satisfaction with treatment, while the former patients’ satisfaction was moderate. There were no significant differences between treatment satisfaction scores for mothers and fathers. However, the former patients’ treatment satisfaction scores were significantly lower than the parents’ scores on several of the items. Correlations between eating disorder outcome parameters and treatment satisfaction were small, except for fathers’ satisfaction with treatment and weight outcome at follow-up. Discussion Family-based treatment adapted to inpatient settings is a novel treatment approach for adolescents with AN that require hospitalization. Inclusion and empowerment of parents are considered crucial in outpatient family-based treatment, but may be just as important in inpatient programs. Mothers and fathers alike reported high levels of satisfaction with treatment, which may constitute an important factor in the success of family-based treatment. Conclusion Family-based inpatient treatment for adolescents with severe AN who have failed to respond to outpatient treatment seemed to be highly valued by parents and viewed by adolescents as acceptable. Parental satisfaction with their child’s treatment is likely to be an important factor for treatment implementation and adherence both in outpatient and inpatient settings

Burnout among staff on specialized eating disorder units in Norway

Objective Burnout is commonly associated with low workplace wellbeing. Patients with eating disorders are frequently referred to as a particularly challenging group to treat. It is therefore important to study healthcare providers´ workplace wellbeing in settings which treat eating disorders. The aims of the current study were to (a) measure burnout among healthcare providers working on specialized eating disorder units in Norway, and (b) explore factors predicting burnout. Methods 186 participants from 11 specialized eating disorder units in Norway completed an online survey including the Mashlach Burnout Inventory, and eating disorder-specific factors related to burnout, job satisfaction, work environment, emotional dissonance and stress. Multiple regression analysis was used to identify predictors of burnout. Results Overall, low levels of burnout were found among the participants. Eating disorder-specific factors and emotional dissonance predicted the three central aspects of burnout, namely, emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. Conclusions Findings suggest a relatively low level of burnout across age, gender, and professional categories working at specialized eating disorder units, contrary to commonly-held assumptions pertaining to the challenges involved in treating individuals with eating disorders

“Time’s up” – staff’s management of mealtimes on inpatient eating disorder units

Background Refeeding and normalizing eating behaviour are main treatment aims for individuals admitted to inpatient eating disorder units. Consequently, mealtime activities are specific, everyday activities, serving a clear therapeutic purpose, despite numerous challenges for both staff and patients. Few studies have specifically addressed staff involvement, interactions, and management activities to structure mealtimes. In this study, we investigated the structure of mealtime activities on inpatient eating disorder units, and identified associated staff behaviour. Methods Descriptive and exploratory qualitative study using video observations to investigate the structure of mealtimes and staff management of mealtime activities. Forty main meals were video recorded and the observational data were analysed using interaction analysis. Results An initial analysis during data screening identified three main parts of the meal: ‘pre-eating’, ‘eating’, and ‘meal completion’. For each part, a regular pattern of activities occurred which were associated with staff behaviour. Conclusions Increased awareness amongst staff regarding how they manage the meal and act through a clear internal structure can help staff members to further explore their behaviours and collaboration during mealtimes, and also contribute to improved interaction with patients during the various phases of the meal

Time trends in healthcare-detected incidence of anorexia nervosa and bulimia nervosa in the Norwegian National Patient Register (2010?2016)

Objective: Few studies have investigated temporal trends in the incidence of eating disorders (EDs). This study investigated time trends in the age‐ and sex‐specific incidence of healthcare‐detected anorexia nervosa (AN) and bulimia nervosa (BN) from 2010 to 2016. Methods: Data were retrieved from the Norwegian National Patient Register as defined by the International Classification of Diseases (ICD‐10): narrowly defined AN (F50.0), broadly defined AN (F50.0 + 50.1), narrowly defined BN (F50.2), and broadly defined BN (F50.2 + 50.3). The average annual percent changes (AAPCs) in incidence rates (IRs) were examined by Joinpoint regression analyses. Results: The overall (i.e., both genders, ages 10–49) rates of AN were stable across the 7‐year period, with IRs ranging from 18.8 to 20.4 per 100,000 for narrowly defined AN and 33.2 to 39.5 per 100,000 for broadly defined AN, whereas overall rates of BN declined. Age‐ and gender‐stratification revealed a significant average annual increase in AN (narrow and broad) among 10‐ to 14‐year‐old girls. The incidence of broadly defined AN also increased significantly among females aged 15–19 years between 2010 and 2012, before leveling off. Nearly universal declines in the incidence of narrowly and broadly defined BN among females occurred. IRs among males were stable and comparatively low, with no significant trends toward increasing or decreasing rates of AN or BN over time. Discussion: Although register‐based studies provide an underestimate of the true incidence and may not accurately reflect population‐level changes in true ED occurrence, this study extends our knowledge regarding trends in the detected incidence of EDs into the second decade of the 21st century