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      Resumption of menses in anorexia nervosa during a course of family-based treatment

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          Abstract

          Background

          The resumption of menses (ROM) is considered an important clinical marker in weight restoration for patients with anorexia nervosa (AN). The purpose of this study was to examine ROM in relation to expected body weight (EBW) and psychosocial markers in adolescents with AN.

          Methods

          We conducted a retrospective chart review at The University of Chicago Eating Disorders Program from September 2001 to September 2011 ( N = 225 females with AN). Eighty-four adolescents (Mean age = 15.1, SD = 2.2) with a DSM-IV diagnosis of AN, presenting with secondary amenorrhea were identified. All participants had received a course of outpatient family-based treatment (FBT), i.e., ~20 sessions over 12 months. Weight and menstrual status were tracked at each therapy session throughout treatment. The primary outcome measures were weight (percent of expected for sex, age and height), and ROM.

          Results

          Mean percent EBW at baseline was 82.0 ( SD = 6.5). ROM was reported by 67.9% of participants (57/84), on average at 94.9 ( SD = 9.3) percent EBW, and after having completed an average of 13.5 ( SD = 10.7) FBT sessions (~70% of standard FBT). Compared to participants without ROM by treatment completion, those with ROM had significantly higher baseline Eating Disorder Examination Global scores ( p = .004) as well as Shape Concern ( p < .008) and Restraint ( p < .002) subscale scores. No other differences were found.

          Conclusions

          Results suggest that ROM occur at weights close to the reference norms for percent EBW, and that high pre-treatment eating disorder psychopathology is associated with ROM. Future research will be important to better understand these differences and their implications for the treatment of adolescents with AN.

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          Most cited references31

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          Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.

          Evidence-based treatment trials for adolescents with anorexia nervosa are few. To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission. Randomized controlled trial. Stanford University and The University of Chicago (April 2005 until March 2009). One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment. Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology. There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up. Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points. clinicaltrials.gov Identifier: NCT00149786.
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            Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa.

            Few of the limited randomized controlled trails (RCTs) for adolescent anorexia nervosa (AN) have explored the effects of moderators and mediators on outcome. This study aimed to identify treatment moderators and mediators of remission at end of treatment (EOT) and 6- and 12-month follow-up (FU) for adolescents with AN (N = 121) who participated in a multi-center RCT of family-based treatment (FBT) and individual adolescent focused therapy (AFT). Mixed effects modeling were utilized and included all available outcome data at all time points. Remission was defined as ≥ 95% IBW plus within 1 SD of the Eating Disorder Examination (EDE) norms. Eating related obsessionality (Yale-Brown-Cornell Eating Disorder Total Scale) and eating disorder specific psychopathology (EDE-Global) emerged as moderators at EOT. Subjects with higher baseline scores on these measures benefited more from FBT than AFT. AN type emerged as a moderator at FU with binge-eating/purging type responding less well than restricting type. No mediators of treatment outcome were identified. Prior hospitalization, older age and duration of illness were identified as non-specific predictors of outcome. Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT). Copyright © 2011 Elsevier Ltd. All rights reserved.
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              What is recovery in adolescent anorexia nervosa?

              The principal aim of this study is to describe the types of problems faced in defining recovery from anorexia nervosa (AN) as well as to illustrate the magnitude that various definitions have on recovery rates for AN. Comparative rates of recovery from AN using a range of definitions (percent ideal body weight, psychological recovery, and combinations of these variables) were calculated using long-term outcome data from a study of adolescents treated for AN. In addition, a Kaplan-Meier survival analysis was used to model recovery over the long-term follow-up period. Recovery rates varied highly, depending on the definition used, from 57.1% to 94.4%. Using survival analysis, the mean time to remission for weight (>85% ideal body weight) was 11.3 months, significantly shorter than for Eating Disorder Examination score recovery at 22.6 months (log rank = 16.1, p = 0.0001). Agreement of definitions of recovery may be dependent on specific goals of a particular study or treatment; however, in order to compare and contrast categorical outcomes, a consistent definition of recovery is needed in the literature. Both weight and psychological symptoms appear to be important in a definition of recovery. (c) 2006 by Wiley Periodicals, Inc.
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                Author and article information

                Contributors
                Journal
                J Eat Disord
                J Eat Disord
                Journal of Eating Disorders
                BioMed Central
                2050-2974
                2013
                8 April 2013
                : 1
                : 12
                Affiliations
                [1 ]Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC3077, Chicago, IL, 60637, USA
                [2 ]Division of Adolescent Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
                [3 ]Department of Pediatrics, The University of Chicago, Chicago, IL, USA
                [4 ]School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
                Article
                2050-2974-1-12
                10.1186/2050-2974-1-12
                4053648
                603147c0-577b-4c72-989d-a20ba332e820
                Copyright © 2013 Faust et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 October 2012
                : 12 January 2013
                Categories
                Research Article

                return of menses,adolescent anorexia nervosa,family-based treatment

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