title: An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. Combined cognitive-behavioral, psychopharmacological and nutritional therapy in bulimia nervosa. Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. Pilot study of a graded exercise program for the treatment of anorexia nervosa. A comparison of short- and long-term family therapy for adolescent anorexia nervosa. The impact of social skills training within an established in-patient treatment programme for anorexia nervosa. Amitriptyline in the Treatment of Anorexia Nervosa: A Double‐Blind, Placebo‐Controlled Study Efficacy of citalopram in anorexia nervosa: a pilot study Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa. A controlled trial of cognitive-behavioural and behavioural treatment of anorexia nervosa. Pilot study of growth hormone administration during the refeeding of malnourished anorexia nervosa patients. Three psychotherapies for anorexia nervosa: a randomized, controlled trial. The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. Predictors of treatment acceptance and completion in anorexia nervosa: implications for future study designs. A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics A controlled trial of cisapride in anorexia nervosa. Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. Does fluoxetine augment the inpatient treatment of anorexia nervosa? Venlafaxine versus fluoxetine in the treatment of atypical anorectic outpatients: A preliminary study Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa Comparison of Family Therapy and Family Group Psychoeducation in Adolescents with Anorexia Nervosa Family versus individual therapy for anorexia: impact on family conflict. Brief psychotherapy in the treatment of anorexia nervosa. Outcome at one year. Family and individual therapy in anorexia nervosa. A 5-year follow-up. Anorexia nervosa. Treatment efficacy of cyproheptadine and amitriptyline. A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Neuroleptics in the short-term treatment of anorexia nervosa. A double-blind placebo-controlled study with sulpiride. A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa. Controlled trial of zinc supplementation in anorexia nervosa. Family Therapy versus Individual Therapy for Adolescent Females with Anorexia Nervosa Randomized controlled trial of warming in anorexia nervosa.
abstract: A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) medication does not appear to be effective in ill , malnourished anorexia nervosa ( AN ) patients . However , it may be effective in preventing relapse after weight restoration . The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects . METHOD Twenty-six subjects with AN participated in a trial of fluoxetine . In a double-blind , placebo-controlled manner , subjects received either nutritional supplements or a nutritional placebo . The nutritional supplement included tryptophan ( the precursor of serotonin ) , vitamins , minerals , and essential fatty acids believed to influence serotonin pathway function . RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo . Moreover , there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms . DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects Fifteen women with bulimia nervosa were treated with a 4-month course of combined cognitive-behavioral , nutritional and antidepressant therapy ( 5 with amineptine and 10 with fluvoxamine ) . Patients were monitored before and after 1 , 2 and 4 months of therapy for body mass index ( BMI ) , for eating disorder symptoms by the Eating Disorder Inventory ( EDI ) and the Bulimic Investigation Test ( BITE ) , and for depression and anxiety by the Hamilton Rating Scale for Depression and for Anxiety ( HRS-D and -A ) . BITE symptoms and gravity improved significantly and equally in the two groups during the 4 months of therapy . Global EDI scores , depression and anxiety decreased but not significantly . BMI was normal before therapy and did not change during treatment BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia OBJECTIVE To determine whether a grade d exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat . METHODS A r and omized controlled trial with outcome measures : change in percent body fat , body mass index ( BMI ) , and Medical Outcomes Survey Short Form 36-item Quality of Life question naire . RESULTS Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were r and omized . There was no difference in change in BMI or percent body fat at 3 months . Quality of life outcomes improved from baseline in the experimental group compared with the control group . However , this difference was not statistically significant . DISCUSSION Incorporation of a grade d exercise program may increase compliance with treatment , but it did not reduce the short-term rate of gain of body fat or BMI . Longer studies with more subjects are necessary to determine the usefulness of a grade d exercise program in anorexia nervosa OBJECTIVE Research suggests that family treatment for adolescents with anorexia nervosa may be effective . This study was design ed to determine the optimal length of such family therapy . METHOD Eighty-six adolescents ( 12 - 18 years of age ) diagnosed with anorexia nervosa were allocated at r and om to either a short-term ( 10 sessions over 6 months ) or long-term treatment ( 20 sessions over 12 months ) and evaluated at the end of 1 year using the Eating Disorder Examination ( EDE ) between 1999 and 2002 . RESULTS Although adequately powered to detect differences between treatment groups , an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups . Although a nonsignificant finding does not prove the null hypothesis , in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level . However , post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment . CONCLUSIONS A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short- duration anorexia nervosa . However , there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment There are no controlled studies of the long term impact of treatment on the evolution of anorexia nervosa , although it is clear that life can sometimes be saved in the short term and that a variety of pharma cological and behavioural approaches can have a short term and limited effect on the low body weight control mechanisms of the patient . During the past 20 years , the second author has run an established in patient combined  behaviour and psychotherapeutic treatment programme  for patients with anorexia nervosa involving restoration of body weight to matched population levels coupled with individual and family psychotherapy ( Crisp , 1967 ) . He believes that this approach does have an impact on the course of the disorder ( Crisp , 1980 ) . However , it is difficult to evaluate it in total in a controlled experimental fashion since , in the event , it is impossible to deny any patient a treatment which almost always has the short term . effect of her gaining weight back to normal adult levels . In recent years , therefore , an alternative strategy has developed in the unit in which specific treatments ( e.g. the impact of tricyclic drugs ( Lacey and Crisp , 1980 ) are experimentally superimposed on the basic treatment programme . This paper reports the impact of a social skills programme exhibited on this basis . Two case reports ( Lang , 1965 and Argyle et a ! , 1974a ) describe the efficacy of behavioural social anxiety treatment  for anorexia nervosa . These studies are limited in diag nostic detail . Wolpe ( 1975 ) advocates the value of the comprehensiveness of a behavioural analysis in treating anorexianervosathatwould includean assessment of the symptom of social anxiety within the clinical condition . A controlled study by Argyle et a ! ( 1974b ) indicates the efficiency of  social skills treat ment as well as brief psychotherapy in positively influencing social ease in a patient population . How ever , no experimental studies are reported on the impact of a behaviourally orientated treatment for social anxiety  on the course of recovery for anorexia nervosa . This treatment was introduced because anorectics are known to be socially isolated and to have low self-esteem ( Crisp , 1970 ; Pillay and Crisp , 1977 ) . Furthermore , previous follow-up studies have revealed that those who have recovered often become socially anxious despite their involvement in psycho therapy directed at this area of difficulty ( Stonehill and Crisp , 1977 ; Crisp , 1980 ) . The hypothesis was that social skills training within the established in-patient treatment programme would lead to a greater degree of recovery from anorexia nervosa at one year follow-up as measured by the percentage matched population mean weight of the patients , and furthermore that these patients would be less socially anxious than those who had not received suchtreatment The tricyclic antidepressant drug amitriptyline was evaluated as a short-term treatment of anorexia nervosa patients . In a 5-week double-blind , placebo-controlled study 11 patients were given amitriptyline and 14 received placebo .  In addition , 18 patients who refused to participate in the drug trial and received only psychosocial treatment were used as an additional comparison group . Overall , patients in the three groups showed little improvement . No statistically significant differences favoring amitriptyline were found in any of the outcome variables . Plasma levels varied widely among patients receiving similar doses . No association was found between plasma levels and improvement in either psychiatric symptomatology or weight .  Amitriptyline patients did not manifest any tendency for a reduction of depressive symptomatology . In addition , amitriptyline treatment was associated with substantial discomfort and adverse affects INTRODUCTION Anorexia nervosa ( AN ) still lacks a defined treatment . Since fluoxetine proved effective in weight-restored anorexics , this pilot study evaluates the efficacy of another SSRI , citalopram , in restricting-type AN . EXPERIMENTAL PROCEDURES Fifty-two female anorectic out patients were r and omized in the citalopram ( n=26 ) and waiting list ( n=26 ) as a control group .  Efficacy was assessed using Eating Disorder Inventory-2 , Eating Disorder Inventory-Symptom Checklist , State-Trait Anger Expression Inventory , Beck Depression Inventory , Symptom Checklist-90 and Structured Clinical Interview for DSM-IV Axis II Disorders . RESULTS Thirteen patients dropped-out , thus 19 patients received citalopram and 20 remained in the control group . After 3 months of treatment , the citalopram group showed a decrease on BDI and SCL-90 Depression subscale and an improvement of baseline obsessive compulsive features on SCL-90 , EDI-2 impulsiveness and Trait-anger on STAXI . Weight gain was similar in the two groups . DISCUSSION These preliminary results support the efficacy of citalopram in anorectics . Citalopram seems to improve depression , obsessive-compulsive symptoms , impulsiveness and Trait-anger Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a st and ard behavioural treatment , in the outpatient therapy of patients with anorexia nervosa . The two treatments were also compared with a control treatment procedure consisting of routine outpatient management .  Each group consisted of eight subjects . All the groups showed some improvement , but the findings did not provide support for the prediction that cognitive-behavioural treatment , design ed specifically to manipulate both attitudes and behaviour , was superior to the other types of treatment . The implication s of the findings are considered OBJECTIVE In anorexia nervosa ( AN ) , medical stabilization and nutritional repletion are pivotal steps toward physical and psychological recovery . Nutritional stabilization is often difficult in this patient group . Recombinant human growth hormone ( rhGH ) has been safely used as adjuvant therapy in other groups of malnourished patients . We hypothesize that rhGH treatment will hasten medical stabilization in AN patients . STUDY DESIGN Fifteen patients admitted for inpatient treatment for AN , ages 12 - 18 years , were enrolled in a 28-day r and omized , double-blind , placebo-controlled study . Patients received rhGH ( 0.05 mg/kg subcutaneously ) or an equivalent volume of placebo daily . Outcome measures included time to reach medical/cardiovascular stability , rate of weight gain , and duration of hospitalization . All patients received a st and ard refeeding protocol . RESULTS Mean admission body mass index was 14.5 kg/m2 . The rhGH and placebo groups did not differ significantly in admission weight , BMI or daily caloric intake . Patients treated with rhGH  reached medical/cardiovascular stability more rapidly than those treated with placebo ( median 17 vs. 37 days , p = 0.02 ) . Numerical but not statistically significant improvements were seen in weight gain and length of hospitalization in the rhGH group . CONCLUSION Patients treated with rhGH achieved medical/cardiovascular stability more rapidly than those treated with placebo , and this , in turn , decreased the length of stay OBJECTIVE Few r and omized , controlled trials have examined the efficacy of treatments for anorexia nervosa .  Cognitive behavior therapy and interpersonal psychotherapy are effective in a related disorder , bulimia nervosa . There are theoretical and treatment indications for these therapies in anorexia nervosa . METHOD Fifty-six women with anorexia nervosa diagnosed by using strict and lenient weight criteria were r and omly assigned to three treatments . Two were specialized psychotherapies ( cognitive behavior therapy and interpersonal psychotherapy ) , and one was a control treatment combining clinical management and supportive psychotherapy ( nonspecific supportive clinical management ) . Therapy consisted of 20 sessions over a minimum of 20 weeks . RESULTS For the total study group ( intent-to-treat group ) , there were significant differences among therapies in the primary global outcome measure . Nonspecific supportive clinical management was superior to interpersonal psychotherapy , while cognitive behavior therapy was intermediate , neither worse than nonspecific supportive clinical management nor better than interpersonal psychotherapy . For the women completing therapy , nonspecific supportive clinical management was superior to the two specialized therapies . CONCLUSIONS The finding that nonspecific supportive clinical management was superior to more specialized psychotherapies was opposite to the primary hypothesis and challenges assumptions about the effective ingredients of successful treatments for anorexia nervosa To study the effects of prolonged anorexia nervosa on bone density ( BD ) and to determine whether estrogen administration prevents bone loss in women with this disorder , 48 amenorrheic women with anorexia nervosa ( mean age , 23.7 yr ) were r and omized to receive estrogen and progestin replacement ( n = 22 ) or no replacement ( n = 26 ) . Clinical variables , biochemical indices , and spinal trabecular BD were measured every 6 months for a mean of 1.5 yr . Initial mean BD ( 130 + /- 27 mg K2HPO4/cm3 , + /- 1 SD ) was significantly ( P < 0.001 ) less than normal ( 176 + /- 26 mg K2HPO4/cm3 ) and less than 2 SD below normal in 21 of the 48 women . Forty-four women completed the study ( 19 in the estrogen group and 25 in the control group ) . The mean duration of follow-up was comparable in the estrogen-treated ( 1.57 + /- 0.89 yr ) vs. the control group ( 1.41 + /- 0.69 yr ) . The estrogen-treated group had no significant change in BD compared with the control group ; however , there was a 4.0 % increase in mean BD in patients with an initial ideal body weight of less than 70 % who were treated with estrogen . In contrast , control patients with comparably low initial weight had a 20.1 % decrease in BD . Women in the control group with spontaneous resumption of menses , all of whom had an initial percent ideal body weight of greater than 70 % , had a 19.3 % increase in bone mass . It is concluded that : 1 ) estrogen replacement can not prevent progressive osteopenia in young women with anorexia nervosa ; 2 ) a subset of patients may have improved BD with estrogen and progestin administration depending on initial body weight ; and 3 ) recovery from anorexia nervosa is associated with significantly improved BD CONTEXT There have been very few r and omized controlled treatment studies of anorexia nervosa . OBJECTIVE To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa . DESIGN R and omized prospect i ve study . SETTING Weill-Cornell Medical Center , White Plains , NY ; University of Minnesota , Minneapolis ; and Stanford University , Stanford , Calif. Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa . INTERVENTIONS Treatment with cognitive-behavioral therapy , fluoxetine hydrochloride , or their combination for 1 year . MAIN OUTCOME MEASURES Dropout rate and acceptance of treatment ( defined as staying in treatment at least 5 weeks ) . RESULTS Of the 122 r and omized cases , 21 ( 17 % ) were withdrawn ; the overall dropout rate was 46 % ( 56/122 ) in the remaining patients . Treatment acceptance occurred in 89 ( 73 % ) of the 122 r and omized cases . Of the 41 assigned to medication alone , acceptance occurred in 23 ( 56 % ) . In the other 2 groups , acceptance rate was differentiated by high and low obsessive preoccupation scores ( rates of 91 % and 60 % , respectively ) . The only predictor of treatment completion was high self-esteem , which was associated with a 51 % rate of treatment acceptance . CONCLUSION Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa . Differing characteristics predict dropout rates and acceptance , which need to be carefully studied before comparative treatment trials are conducted 1 . The study evaluated the efficacy of amisulpride , fluoxetine and clomipramine at the beginning of the re-feeding phase of the treatment of restricting anorexia nervosa according to DSM-IV criteria . 2 . 13 patients , mean weight 37.61 kg + /- 9.80 SD , were treated with clomipramine at a mean dosage of 57.69 mg + /- 25.79 SD ; 10 patients , mean weight 40.90 kg + /- 6.98 SD , were treated with fluoxetine at a mean dosage of 28.00 mg + /- 10.32 SD ; 12 patients , mean weight 38.41 kg + /- 8.33 SD , were treated with amisulpride at a mean dosage of 50.00 mg + /- 0.00 SD . 3 . Clinical evaluation was carried out under single-blind condition at basal time and after three months by a structured clinical interview , the Eating Disorder Interview based on Long Interval Follow-up Evaluation ( LIFE II BEI ) . 4 . Patients treated with amisulpride showed a more significant increase ( p=0.016 ) of mean weight . Concerning weight phobia , body image disturbance and amenorrhoea , no significant difference result ed To determine the efficacy of cisapride , 10 mg three times daily , in improving gastric emptying , reducing distress during meals , and facilitating weight gain in anorexia nervosa , we conducted an 8-week , r and omized , double-blind ,  placebo-controlled trial on 29 in patients . Measures included scintigraphic gastric emptying studies at 0 , 2 , 4 , and 8 weeks ; subjective distress during meals measured by visual analogue scales ; self-rating of degree of global improvement in symptoms associated with eating at end of study ; and weight measured weekly . Gastric emptying improved significantly but equally in both groups over the study period . Yet subjective measures were better in the cisapride group ; they rated themselves as more hungry ( p = .02 ) and more improved on the global measure of change in symptoms ( p = .02 ) . Even so , the  cisapride group did not gain more weight . The correlation between gastric emptying and weight gain was modest ( r = .30 ; p = .11 ) , and between gastric emptying and the subjective measures , virtually absent OBJECTIVE This study provides what the authors believe is the first empirical evaluation of cognitive behavior therapy as a posthospitalization treatment for anorexia nervosa in adults . METHOD After hospitalization , 33 patients with DSM-IV anorexia nervosa were r and omly assigned to 1 year of outpatient cognitive behavior therapy or nutritional counseling . RESULTS The group receiving nutritional counseling  relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy ( 53 % versus 22 % ) . The overall treatment failure rate ( relapse and dropping out combined ) was significantly lower for cognitive behavior therapy ( 22 % ) than for nutritional counseling ( 73 % ) . The criteria for " good outcome " were met by significantly more of the patients receiving cognitive behavior therapy ( 44 % ) than nutritional counseling ( 7 % ) . CONCLUSIONS Cognitive behavior therapy was significantly more effective than nutritional counseling in improving outcome and preventing relapse . To the authors ' knowledge , these data provide the first empirical documentation of the efficacy of any psychotherapy , and cognitive behavior therapy in particular , in posthospitalization care and relapse prevention of adult anorexia nervosa Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group OBJECTIVE While pharmacological interventions are of established utility in bulimia nervosa , medications have no clear role in the treatment of anorexia nervosa . Because patients with anorexia nervosa frequently exhibit mood disturbances and symptoms of obsessive-compulsive disorder , the authors tested the utility of fluoxetine in the treatment of women participating in an inpatient program for anorexia nervosa . METHOD The authors conducted a r and omized , placebo-controlled , double-blind , 7-week study of fluoxetine at a target daily dose of 60 mg in 31 women with anorexia nervosa receiving treatment for their eating disorder on a clinical research unit .  Body weight and measures of eating behavior and psychological state were obtained at baseline and at termination . RESULTS There were no significant differences in clinical outcome on any measure between patients receiving fluoxetine and patients receiving placebo . CONCLUSIONS Fluoxetine does not appear to add significant benefit to the inpatient treatment of anorexia nervosa The efficacy of venlafaxine and fluoxetine in the treatment of atypical anorexia nervosa ( AN ) was compared in a controlled trial . A consecutive series of 24 atypical anorectic females was assigned to either venlafaxine ( 75 mg/day ) or fluoxetine ( 40 mg/day ) plus cognitive-behavioural therapy ( CBT ) .  Eating Disorder Examination ( EDE12.0D ) , Beck Depression Inventory ( BDI ) and State and Trait Anxiety Inventory ( STAI ) scores were compared before and after 6 months of treatment . Venlafaxine and fluoxetine determined an increase of body mass index ( BMI ) and a significant reduction of EDE12.0D and BDI scores venlafaxine alone reduced STAI scores . It would seem that venlafaxine is as effective as fluoxetine when combined with CBT in the treatment of atypical AN BACKGROUND Anorexia nervosa is an often chronic disorder with high morbidity and mortality . Many people relapse after weight restoration . This study was design ed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms . METHODS We administered a double-blind placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa . Anorexics were r and omly assigned to fluoxetine ( n = 16 ) or a placebo ( n = 19 ) after inpatient weight gain and then were observed as out patients for 1 year . RESULTS Ten of 16 ( 63 % ) subjects remained on fluoxetine for a year , whereas only three of 19 ( 16 % ) remained on the placebo for a year ( p = .006 ) . Those subjects remaining on fluoxetine for a year had reduced relapse as determined by a significant increase in weight and reduction in symptoms . CONCLUSIONS This study offers preliminary evidence that fluoxetine may be useful in improving outcome and preventing relapse of patients with anorexia nervosa after weight restoration Objective : To compare the effects of 4 months of 2 family-oriented treatments , family therapy and family psychoeducation , on female adolescents with newly diagnosed restrictive eating disorders . Method : Twenty-five female adolescents requiring hospitalization were r and omized into either family therapy or family group psychoeducation . Outcome measures included medical ( body weight ) and psychosocial ( specific and nonspecific eating disorder psychopathology ) variables at baseline and after 4 months of treatments every 2 weeks . Results : A significant time effect was found in both treatment groups for the restoration of body weight ( percentage of ideal body weight , P < 0.000 01 ) . The group averages ranged from 75 % to 77 % ideal body weight before treatment to 91 % to 96 % after it . A time effect was also seen on the Family Assessment Measure ( P < 0.018 ) , in that the patients of both groups acknowledged more family psychopathology at the end of treatment . No significant group differences were found on any of the self-report measures of specific and nonspecific eating disorder pathology . Conclusions : Weight restoration was achieved following the 4-month period of treatment in both the family therapy and family psychoeducation groups , but no significant change was reported in psychological functioning by either adolescents or parents . Family group psychoeducation , the less expensive form of treatment , is an equally effective method of providing family-oriented treatment to newly diagnosed , medically compromised anorexia nervosa patients and their families This study evaluated the impact on family relations of behavioral family systems therapy ( BFST ) versus ego-oriented individual therapy ( EOIT ) as treatments for adolescents with anorexia nervosa . Twenty-two adolescents meeting DSM-III-R anorexia nervosa criteria were r and omly assigned to receive approximately 16 months of either BFST or EOIT along with a common medical and dietary regimen . BFST emphasized parental control over eating , cognitive restructuring , and problem-solving communication training . EOIT emphasized building ego strength , adolescent autonomy , and insight . Measures including body mass index , self-reported general and eating-related conflict , and observed general and eating-related communication . Both treatments produced significant reductions in negative communication and parent-adolescent conflict , with some differences between condition and between eating and non-eating related measures ; the improvements in eating-related conflict were maintained at a 1-year follow-up . The study demonstrated that structured therapies for adolescent anorexia do impact family relations , even when the family is never seen as a unit during the therapy Thirty out- patients with severe anorexia nervosa were r and omly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy . At one-year follow-up both groups showed significant overall improvement , and the dietary advice group showed significant weight gain . A similar mean weight gain for the psychotherapy patients did not reach statistical significance , but this group made significant improvements in sexual and social adjustment BACKGROUND There is evidence that specific psychological treatments are effective in patients with eating disorders . Our goal was to determine by means of a controlled trial whether psychological treatments , previously found to be effective in anorexia nervosa , gave rise to enduring benefits . METHODS A 5-year follow-up was conducted on patients who had participated in a previous trial of family therapy for anorexia and bulimia nervosa .  Family therapy or individual supportive therapy had been administered to 80 out patients for 1 year beginning on discharge from hospital after weight restoration . The 80 patients had been subdivided into 4 prognostically homogeneous groups of which 2 turned out to be the most important : patients with early onset and short history of anorexia nervosa , and patients with late-onset anorexia nervosa . At the 5-year follow-up , the efficacy of the outpatient therapies was again assessed by the maintenance of weight , and the categories of general outcome and dimensions of clinical functioning defined by the Morgan-Russell scales . RESULTS Significant improvements were found in the group of 80 patients as a whole , mainly attributable to the natural outcome of anorexia nervosa , and most evident in the early onset and short history group , as expected . Within 2 of the prognostic groups , significant benefits attributable to previous psychological treatments were still evident , favoring family therapy for patients with early onset and short history of anorexia nervosa and favoring individual supportive therapy for patients with late-onset anorexia nervosa . CONCLUSIONS Much of the improvements found at a 5-year follow-up can be attributed to the natural outcome of the illness . Nevertheless , it was still possible to detect long-term benefits of psychological therapies completed 5 years previously Patients with anorexia nervosa have concurrent problems of emaciation and depression . Therefore , treatment with medications affecting both weight gain and depression seemed reasonable . Seventy-two anorectic patients were r and omly assigned in a double-blind study to receive cyproheptadine hydrochloride , a weight-inducing drug , amitriptyline hydrochloride , a tricyclic antidepressant , or placebo . Overall , cyproheptadine had a marginal effect on decreasing the number of days necessary to achieve a normal weight . There was a differential drug effect present in the bulimic subgroups of the anorectic patients : cyproheptadine significantly increased treatment efficiency for the nonbulimic patients and significantly impaired treatment efficiency for the bulimic patients when compared with the amitriptyline- and placebo-treated groups . The differential cyproheptadine effect on the anorectic bulimic subgroups is the first pharmacologic evidence of the validity of these subgroups . Cyproheptadine had an anti-depressant effect demonstrated by a significant decrease in the Hamilton depression ratings OBJECTIVE To compare the effectiveness of behavioral family systems therapy ( BFST ) with that of ego-oriented individual therapy ( EOIT ) as treatments for adolescents with anorexia nervosa . METHOD Thirty-seven adolescents meeting DSM-III-R criteria for anorexia nervosa were r and omly assigned to receive BFST or EOIT , in addition to a common medical and dietary regimen . In BFST , the family was seen conjointly , the parents were placed in control of the adolescent 's eating , distorted beliefs were targeted through cognitive restructuring , and strategic/behavioral interventions were used to change family interactions . In EOIT , the adolescent was seen individually , with an emphasis on building ego strength and uncovering the dynamics blocking eating ; parents were seen collaterally . Measures administered before , after , and at 1-year follow-up tapped body mass index , menstruation , eating attitudes , ego functioning , depression , and family interactions . RESULTS BFST produced greater weight gain and higher rates of resumption of menstruation than EOIT . Both treatments produced comparably large improvements in eating attitudes , depression , and eating-related family conflict , but very few changes occurred on ego functioning . CONCLUSIONS BFST and EOIT proved to be effective treatments for adolescents with anorexia nervosa , but BFST produced a faster return to health There is a remarkable lack of controlled investigations about the usefulness of psychotropic drugs in anorexia nervosa despite the popular use of neuroleptics in these patients . Inspired by a previous study using pimozide , a double-blind placebo-controlled cross-over study with sulpiride was carried out in 18 female anorexia nervosa in patients . No direct effect of sulpiride has been established with regard to behavioural and attitudinal characteristics as measured by behaviour observation scales as well as by two self-report question naires ( Eating Attitudes Test , Body Attitudes Test ) . Regarding daily weight gain , sulpiride was on the whole superior to placebo , especially in the first treatment period of three weeks . In the cross-over analysis , however , this effect did not reach statistical significance The aim of this study was to compare two forms of outpatient treatment , educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa . Thirty patients were r and omly allocated to the two treatments . At one year , the group had gained 6.8 kg , 19/30 ( 63 % ) had a good or intermediate recovery in terms of nutritional outcome . The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters . In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases . Larger studies will be needed to determine the most effective form of treatment in this group Zinc supplementation of anorexia nervosa ( AN ) patients has been reported to increase the weight gain of AN patients in open trials . In this r and omized , double-blind , placebo-controlled trial 100 mg of zinc gluconate , or placebo , was given daily to 35 female AN in patients until they achieved a 10 % increase in body mass index ( BMI ) . The rate of increase in BMI of the zinc supplemented group ( n = 16 ) was twice that of the placebo group ( n = 19 ) , and this difference was statistically significant ( p = .03 ) . The use of zinc supplementation should be considered in the treatment of AN patients Behavioral family systems therapy ( BFST ) was compared with ego-oriented individual therapy ( EOIT ) in a controlled , r and om-assignment investigation involving 22 young adolescents with anorexia nervosa . Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen . BFST emphasized parental control over eating and weight gain , coupled with cognitive restructuring and problem-solving communication training . EOIT emphasized building ego strength , adolescent autonomy , and insight into the emotional blocks to eating . BFST produced greater change on body-mass index than did EOIT , but both treatments produced comparable improvements on eating attitudes , body shape dissatisfaction , interoceptive awareness , depression/internalizing psychopathology , and eating-related family conflict . The implication s of these results for the clinician who treats adolescents with anorexia nervosa are discussed . J Dev Behav Pediatr 15:111–116 , 1994 . Index terms : anorexia nervosa , adolescents , family therapy , individual therapy OBJECTIVE To determine if warming therapy increases the rate of weight gain in patients with anorexia nervosa ( AN ) who are hospitalized for refeeding . METHOD Patients admitted to an eating disorders unit of a university teaching hospital were r and omized to treatment and control arms . All patients wore a heating vest for 3 hr a day for 21 days . In the experimental arm , the vest was set to medium heat and in the control arm it was set in the off position . RESULTS Twenty-one females were recruited . They had an average age of 28.4 + /- 6.6 years , a body mass index ( BMI ) of 17.7 + /- 2.8 , and the duration of AN lasted 13.6 + /- 6.7 years . Ten subjects were r and omized to the treatment arm and 11 to the control arm . Of the 18 completers , there was no difference in the change in BMI . DISCUSSION Our study did not demonstrate an increase in the rate of weight gain with warming
target: Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration , although its efficacy in the underweight state remains unknown .
  Variants of family therapy are efficacious in adolescents , but not in adults .
  Evidence for AN treatment is weak ; evidence for treatment-related harms and factors associated with efficacy of treatment are weak ; and evidence for differential outcome by sociodemographic factors is nonexistent .
background: OBJECTIVE The RTI International-University of North Carolina at Chapel Hill Evidence -based Practice Center ( RTI-UNC EPC ) systematic ally review ed evidence on efficacy of treatment for anorexia nervosa ( AN ) , harms associated with treatments , factors associated with treatment efficacy , and differential outcome by sociodemographic characteristics .