The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group.</p> <p>Methods/Design</p> <p>237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization).</p> <p>Discussion</p> <p>The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual".</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN72809357</p

Functional connectivity underlying hedonic response to food in female adolescents with atypical AN: the role of somatosensory and salience networks.

Atypical anorexia nervosa (AN) usually occurs during adolescence. Patients are often in the normal-weight range at diagnosis; however, they often present with signs of medical complications and severe restraint over eating, body dissatisfaction, and low self-esteem. We investigated functional circuitry underlying the hedonic response in 28 female adolescent patients diagnosed with atypical AN and 33 healthy controls. Participants were shown images of food with high (HC) or low (LC) caloric content in alternating blocks during functional MRI. The HC > LC contrast was calculated. Based on the previous literature on full-threshold AN, we hypothesized that patients would exhibit increased connectivity in areas involved in sensory processing and bottom-up responses, coupled to increased connectivity from areas related to top-down inhibitory control, compared with controls. Patients showed increased connectivity in pathways related to multimodal somatosensory processing and memory retrieval. The connectivity was on the other hand decreased in patients in salience and attentional networks, and in a wide cerebello-occipital network. Our study was the first investigation of food-related neural response in atypical AN. Our findings support higher somatosensory processing in patients in response to HC food images compared with controls, however HC food was less efficient than LC food in engaging patients' bottom-up salient responses, and was not associated with connectivity increases in inhibitory control regions. These findings suggest that the psychopathological mechanisms underlying food restriction in atypical AN differ from full-threshold AN. Elucidating the mechanisms underlying the development and maintenance of eating behavior in atypical AN might help designing specific treatment strategies

Distinct contributions of extrastriate body area and temporoparietal junction in perceiving one's own and others' body.

The right temporoparietal cortex plays a critical role in body representation. Here, we applied repetitive transcranial magnetic stimulation (rTMS) over right extrastriate body area (EBA) and temporoparietal junction (TPJ) to investigate their causative roles in perceptual representations of one's own and others' body. Healthy women adjusted size-distorted pictures of their own body or of the body of another person according to how they perceived the body (subjective task) or how others perceived it (intersubjective task). In keeping with previous reports, at baseline, we found an overall underestimation of body size. Crucially, EBA-rTMS increased the underestimation bias when participants adjusted the images according to how others perceived their own or the other woman's body, suggesting a specific role of EBA in allocentric body representations. Conversely, TPJ-rTMS increased the underestimation bias when participants adjusted the body of another person, either a familiar other or a close friend, in both subjective and intersubjective tasks, suggesting an involvement of TPJ in representing others' bodies. These effects were body-specific, since no TMS-induced modulation was observed when participants judged a familiar object. The results suggest that right EBA and TPJ play active and complementary roles in the complex interaction between the perceptions of one's own and other people's body

Anxiety and depression symptoms in women with and without binge eating disorder enrolled in weight loss programs

OBJECTIVES: 1) To investigate the association between binge eating scores, anxiety and depression symptoms, and body mass index (BMI), and 2) to assess the presence of differences in severity of anxiety symptoms, severity of depression symptoms, and BMI in women with and without binge eating disorder. METHOD: The sample comprised 113 women aged between 22 and 60 years (39.35±10.85) enrolled in weight loss programs in Porto Alegre, southern Brazil. The following instruments were used: structured interview, Brazilian Economic Classification Criteria, Beck Anxiety Inventory, Beck Depression Inventory, and Binge Eating Scale. Data were analyzed using descriptive and inferential statistics. RESULTS: A positive association was found between binge eating scores and the severity of anxiety symptoms (p OBJETIVOS: 1) Investigar a associação entre escores de compulsão alimentar, sintomas de ansiedade e de depressão e índice de massa corporal (IMC); e 2) verificar se existe diferença na intensidade dos sintomas de ansiedade, dos sintomas depressivos e no IMC em mulheres com e sem compulsão alimentar. MÉTODO: A amostra foi composta de 113 mulheres com idade entre 22 e 60 anos (39,35±10,85), participantes de programas de redução de peso na cidade de Porto Alegre, sul do Brasil. Foram aplicados os seguintes instrumentos: entrevista estruturada, Critérios de Classificação Econômica Brasil, Inventário de Ansiedade de Beck, Inventário de Depressão de Beck e Escala de Compulsão Alimentar Periódica. Os dados foram analisados utilizando-se estatística descritiva e inferencial. RESULTADOS: Houve associação positiva entre os escores de compulsão alimentar e a intensidade dos sintomas de ansiedade (p < 0,001) e de depressão (p < 0,001). Não foi observada associação significativa (p = 0,341) entre IMC e escores de compulsão alimentar. Houve diferença significativa entre mulheres com e sem compulsão alimentar com relação à intensidade dos sintomas de ansiedade (p < 0,001) e depressão (p < 0,001). Não foi encontrada diferença significativa entre os grupos com relação ao IMC (p = 0,103). CONCLUSÃO: Os achados deste estudo mostraram que a compulsão alimentar está associada a sintomas de ansiedade e de depressão, porém não está associada ao IMC