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Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial

  • Ulrike Schmidt (a1), Anna Oldershaw (a1), Fatima Jichi (a2), Lot Sternheim (a1), Helen Startup (a3), Virginia McIntosh (a4), Jennifer Jordan (a4), Kate Tchanturia (a1), Geoffrey Wolff (a3), Michael Rooney (a3), Sabine Landau (a2) and Janet Treasure (a1)...

Abstract

Background

Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor. Novel treatment approaches are urgently needed.

Aims

To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) compared with specialist supportive clinical management (SSCM) in a randomised controlled trial.

Method

Seventy-two adult out-patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK. Participants were randomly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need (trial registration: ISRCTN62920529). The primary outcomes were body mass index, weight and global score on the Eating Disorders Examination at end of treatment (6 months) and follow-up (12 months). Secondary outcomes included: depression, anxiety and clinical impairment; neuropsychological outcomes; recovery rates; and additional service utilisation.

Results

At baseline, patients randomised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM (3/34 v. 10/36; P < 0.05). Patients in both treatments improved significantly in terms of eating disorder and other outcomes, with no differences between groups. Strictly defined recovery rates were low. However, MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM (7/34 v. 0/37; P=0.004).

Conclusions

Adults with anorexia nervosa are a difficult to treat group. The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM. This study confirms SSCM as a useful treatment for out-patients with anorexia nervosa. The novel treatment, MANTRA, designed for this patient group may need adaptations to fully exploit its potential.

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Copyright

Corresponding author

Professor Ulrike Schmidt, Section of Eating Disorders Unit (PO59), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email: ulrike.schmidt@kcl.ac.uk

Footnotes

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Joint last authors.

Declaration of interest

U.S. receives salary support from the NIHR (Mental Health Biomedical Research Centre) at South London and Maudsley NHS Foundation Trust and King's College London.

Footnotes

References

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Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial

  • Ulrike Schmidt (a1), Anna Oldershaw (a1), Fatima Jichi (a2), Lot Sternheim (a1), Helen Startup (a3), Virginia McIntosh (a4), Jennifer Jordan (a4), Kate Tchanturia (a1), Geoffrey Wolff (a3), Michael Rooney (a3), Sabine Landau (a2) and Janet Treasure (a1)...

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