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Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  13 August 2018

Stuart B. Murray*
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA, USA
Daniel S. Quintana
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
Katharine L. Loeb
Affiliation:
School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
Scott Griffiths
Affiliation:
School of Psychology, University of Melbourne, Melbourne, VIC, Australia
Daniel Le Grange
Affiliation:
Department of Psychiatry, University of California, San Francisco, CA, USA Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, USA
*
Author for correspondence: Stuart B. Murray, E-mail: stuart.murray@ucsf.edu, drstuartmurray@gmail.com

Abstract

Background

To determine the impact of specialized treatments, relative to comparator treatments, upon the weight and psychological symptoms of anorexia nervosa (AN) at end-of-treatment (EOT) and follow-up.

Methods

Randomized controlled trials (RCTs) between January 1980 and December 2017 that reported the effects of at least two treatments on AN were screened. Weight and psychological symptoms were analyzed separately for each study. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and studies were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria and Cochrane risk of bias tool.

Results

We identified 35 eligible RCTs, comprising data from 2524 patients. Meta-analyses revealed a significant treatment effect on weight outcomes at EOT [g = 0.16, 95% CI (0.05–0.28), p = 0.006], but not at follow-up [g = 0.11, 95% CI (−0.04 to 0.27), p = 0.15]. There was no significant treatment effect on psychological outcomes at either EOT [g = −0.03, 95% CI (−0.14 to 0.08), p = 0.63], or follow-up [g = −0.001, 95% CI (−0.11 to 0.11), p = 0.98]. There was no strong evidence of publication bias or significant moderator effects for illness duration, mean age, year of publication, comparator group category, or risk of bias (all p values > 0.05).

Conclusions

Current specialized treatments are more adept than comparator interventions at imparting change in weight-based AN symptoms at EOT, but not at follow-up. Specialized treatments confer no advantage over comparator interventions in terms of psychological symptoms. Future precision treatment efforts require a specific focus on the psychological symptoms of AN.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2018 

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