Skip to main content
×
×
Home

A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

  • Calum Munro (a1) (a2), Victoria Thomson (a1), Jean Corr (a1), Louise Randell (a1), Jennie E. Davies (a1), Claire Gittoes (a1), Vicky Honeyman (a1) and Chris P. Freeman (a1) (a3)...
Abstract
Aims and method

A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described.

Results

Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced.

Clinical implications

There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Bulik, CM, Berkman, ND, Brownley, KA, Sedwan, JA, Lohr, KN. Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord 2007; 40: 310–20.
2 Meads, C, Gold, L, Burls, A. How effective is out-patient care compared to in-patient care for the treatment of anorexia nervosa? A systematic review. Eur Eat Disord Rev 2001; 9: 229–41.
3 National Institute for Clinical Excellence. Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders (Clinical Guideline CG9). NICE, 2004.
4 NHS Quality Improvement Scotland. Eating Disorders in Scotland: Recommendations for Management and Treatment. NHS Quality Improvement Scotland, 2006.
5 Darwish, A, Salmon, G, Ahuja, A, Steed, L. The community intensive therapy team: development and philosophy of a new service. Clin Child Psychol Psychiatry 2006; 11: 591605.
6 Kong, S. Day treatment programme for patients with eating disorders: randomised controlled trial. J Adv Nurs 2005; 51: 514.
7 Collin, P, Power, K, Karatzias, T, Grierson, D, Yellowlees, A. The effectiveness of, and predictors of response to, in-patient treatment of anorexia nervosa. Eur Eat Disord Rev 2010; 18: 464–74.
8 Brewerton, TD, Costin, C. Treatment results of anorexia nervosa and bulimia nervosa in a residential treatment program. Eat Disord 2011; 19: 117–31.
9 Young, JE, Klosko, JS, Weishaar, ME. Schema Therapy: A Practitioner's Guide. Guilford Press, 2003.
10 Simpson, S. Schema therapy for eating disorders: a case study illustration of the mode approach. In The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research and Practice (eds van Vreeswijk, M, Broersen, J, Nadort, M): 145–73. John Wiley & Sons, 2012.
11 Waller, H, Kennerley, H, Ohanian, V. Schema-focussed cognitive behaviour therapy with eating disorders. In Cognitive Schemas and Core Beliefs in Psychological Problems: A Scientist Practitioner Guide (eds Riso, LP, du Toit, PL, Stein, DJ, Young, JE): 139–75. American Psychiatric Association, 2007.
12 McIntosh, VVW, Jordan, J, Luty, SE, Carter, FA, McKenzie, JM, Bulik, CM, et al Specialist supportive clinical management for anorexia nervosa. Int J Eat Disord 2006; 39: 625–32.
13 Harris, EC, Barraclough, B. Excess mortality of mental disorder. A meta-analysis. Br J Psychiatry 1998; 173: 1153.
14 Warren, CS, Schafer, KJ, Crowley, ME, Olivardia, R. A qualitative analysis of job burnout in eating disorders treatment providers. Eat Disord 2012; 20: 175–95.
15 Touyz, S, Le Grange, D, Lacey, H, Hay, P, Smith, R, Maguire, A, et al Treating severe and enduring anorexia nervosa: a randomized controlled trial. Psychol Med 2013; 43: 2501–11.
16 Williams, KD, Dobney, T, Geller, J. Setting the eating disorder aside: an alternative model of care. Eur Eat Disord Rev 2010; 18: 90–6.
17 Button, EJ, Chadalavada, B, Palmer, RL. Mortality and predictors of death in a cohort of patients presenting to an eating disorders service. Int J Eat Disord 2010; 43: 387–92.
18 Crow, SJ, Peterson, CB, Swanson, SA, Raymond, NC, Specker, S, Eckert, ED, et al increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry 2009; 166: 1342–6.
19 Millar, HR, Wardell, F, Vyvyan, JP, Naji, SA, Prescott, GJ, Eagles, JM. Anorexia nervosa mortality in northeast Scotland, 1965–1999. Am J Psychiatry 2005; 162: 753–7.
20 Tanaka, H, Kiriike, N, Nagata, T, Riku, K. Outcome of severe anorexia nervosa patients receiving in-patient treatment in Japan: an 8-year follow-up study. Psychiatry Clin Neurosci 2001; 55: 389–96.
21 Rosling, AM, Sparen, P, Norring, C, Knorring, A. Mortality of eating disorders: a follow-up study of treatment in a specialist unit 1974–2000. Int J Eat Disord 2011; 44: 304–10.
22 Bewell, CV. Carter, JC. Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. Int J Eat Disord 2008; 41: 368–71.
23 Gaudiani, JL, Sabel, AL, Mascolo, M, Mehler, PS. Severe anorexia nervosa: outcomes from a medical stabilization unit. Int J Eat Disord 2012; 45: 8592.
24 Tchanturia, K, Morris, RG, Brecelj Anderluh, M, Collier, DA, Nikolaou, V, Treasure, J. Set shifting in anorexia nervosa: an examination before and after weight gain, in full recovery, and relationship to childhood and adult OCPD traits. J Psychiatr Res 2004; 38: 545–52.
25 Moser, DJ, Benjamin, ML, Bayless, JD, McDowell, BD, Paulsen, JS, Burrows, WA, et al Neuropsychological functioning pre-treatment and post-treatment in an in-patient eating disorders program. Int J Eat Disord 2003; 33: 6470.
26 Oldershaw, A, DeJong, H, Hambrook, D, Broadbent, H, Tchanturia, K, Treasure, J, et al Emotional processing following recovery from anorexia nervosa. Eur Eat Disord Rev 2012; 20: 502–9.
27 Harrison, A, Sullivan, S, Tchanturia, K, Treasure, J. Attentional bias, emotion recognition and emotion regulation in anorexia nervosa: state or trait? Biol Psychiatry 2010; 68: 755–61.
28 Oldershaw, A, Hambrook, D, Tchanturia, K, Treasure, J, Schmidt, U. Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom Med 2010; 72: 73–9.
29 Tchanturia, K, Liao, PC, Uher, R, Laurence, N, Treasure, J, Campbell, IC. An investigation of decision making in anorexia nervosa using the Iowa Gambling Task and skin conductance measurements. J Int Neuropsychol Soc 2007; 13: 635–41.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Munro et al. supplementary material
Supplementary Material

 PDF (64 KB)
64 KB
PDF
Supplementary materials

Munro et al. supplementary material
Supplementary Material

 PDF (33 KB)
33 KB

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 56 *
Loading metrics...

Abstract views

Total abstract views: 284 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 20th July 2018. This data will be updated every 24 hours.

A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

  • Calum Munro (a1) (a2), Victoria Thomson (a1), Jean Corr (a1), Louise Randell (a1), Jennie E. Davies (a1), Claire Gittoes (a1), Vicky Honeyman (a1) and Chris P. Freeman (a1) (a3)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *