Angelika Weigel

Paths to first treatment and duration of untreated illness in anorexia nervosa: are there differences according to age of onset?

This study examined paths to first treatment and the duration of untreated illness in 140 anorexia nervosa patients using validated questionnaires and a clinical interview. The differences between individuals with an early (≤14 years, n = 40), intermediate (15-18 years, n = 53) and late onset (≥19 years, n = 47) were investigated. Participants were most commonly informed about their diagnosis and first treatment facility through general practitioners and paediatricians. The duration of untreated illness exceeded 2 years in the complete sample (25.14 months) and was longest for individuals with an early onset. The early onset group was more often externally vs. internally motivated and more frequently informed about treatment options by their social network, e.g. parents, than patients with a late onset. The results emphasize the relevance of training general practitioners and paediatricians about anorexia, the need to include parents and teachers in eating disorder prevention and to improve targeting young individuals in early interventions.

Correlates of health related quality of life in anorexia nervosa

OBJECTIVE We examined the association between disorder specific factors, comorbidity and health related quality of life (HRQoL) in anorexia nervosa (AN). METHOD HRQoL was assessed using the EuroQol-5D visual analog scale (EQ-VAS) in this cross-sectional study. Three regression models were estimated to determine the association between AN subtype (restrictive vs. binge/purge), duration of the eating disorder (ED), age (adolescents vs. adults), ED pathology (EDE-Q), Body Mass Index (BMI), depressive symptoms (PHQ-9), somatic complaints (PHQ-15), anxiety (GAD-7) and EQ-VAS. RESULTS The sample comprised 218 female AN patients (mean age = 23.3 years [SD = 8.2]; mean EQ-VAS score = 53.4 [SD = 21.4]). A lower BMI, higher levels of depressive symptoms, and somatic complaints were significantly associated with lower EQ-VAS scores. DISCUSSION Findings of the present study suggest that BMI and comorbidity might be more relevant to HRQoL impairments in AN than age, diagnostic subtype, duration of the ED or current psychopathology.

Decreasing the duration of untreated illness for individuals with anorexia nervosa: study protocol of the evaluation of a systemic public health intervention at community level

BackgroundAnorexia nervosa (AN) is a mental disorder with grave burdens for affected individuals as well as for the healthcare system. One of the strongest predictors of a poor outcome is a long Duration of Untreated Illness (DUI), which is defined as the time between the onset of the disease and treatment initiation. Reducing the DUI is an important step to optimize care of individuals with AN. In order to achieve this aim, systemic public health interventions are necessary. Objective of this study is to evaluate a systemic public health intervention at Community level aiming to reduce the DUI in individuals with AN.Methods/designThe intervention includes the establishment of a network of health care professionals within the area of eating disorders (EDs), the development of an internet-based treatment guide, the presentation of informative short-films about EDs in cinemas and a corresponding poster campaign as well as a special outpatient clinic. For the evaluating study a pre-post between-subject design is chosen. The DUI, and the duration until first contact (DUC) with a health care professional, ED pathology as well as comorbidity are assessed before and after the systemic intervention is carried out.DiscussionThe study attempts to provide evidence of the effectiveness of an ED-related systematic public health intervention. Additionally, the study will lead to a better understanding of the DUI, which is essential in order to improve care of individuals with AN.Trial registrationCurrent Controlled Trials ISRCTN44979231; Registered 11 November 2011.

Preventing eating disorders with an interactive gender-adapted intervention program in schools: Study protocol of a randomized controlled trial

BackgroundThere are a high number of adolescents who are at risk of developing an eating disorder. There is, therefore, a strong need to implement prevention programs aimed at reducing the incidence of eating disorders at this critical age. Among other factors, successful prevention programs have been shown to be interactive, carried out by professionals, focused on educational as well as psychosocial elements and have taken risk factors as well as resources into account. The objective of this study protocol is to present the design of a new prevention program for eating disorders in schools.Methods/DesignThe gender-adapted prevention program extends over six school hours. It contains interactive and educational elements about eating disorders and their treatment. Participants pass through different exercises and reflect on the influences of the media, self-esteem, body perception and individual resources. A cluster-randomized controlled trial is chosen to evaluate the program. Based on an estimated effect size of d = 0.3 a total of 1848 participants are enrolled in the study. Eating disorder risk, internalization of Western beauty ideals, body dissatisfaction, self-concept as well as anxiety and symptoms of depression are measured before and immediately after the intervention as well as at a six-month follow-up. In addition, the intervention group evaluates the different components of the program.DiscussionThe study intends to test the practicability and efficacy of an interactive, gender-adapted ED prevention program in schools. Moreover, it will provide valuable information about the occurrence of eating disorder risk factors in school-aged children.Trial registrationISRCTN97989348; Registered 19 December 2012.

A European research network to improve diagnosis, treatment and care for patients with persistent somatic symptoms : Work report of the EURONET-SOMA conference series

Persistent somatic symptoms are common and complex phenomena which pose major challenges to psychosomatics and many other medical specialties across Europe. They are frequent and can affect every organ system [1], individuals of all ages, ethnic groups and socioeconomic strata [2]. Chronic courses of disorders are common [3] and significantly impair quality of life [4,5] and increase health care use [6] as well as health care costs [7]. The different concepts of persistent somatic symptoms across medical specialties, clinical psychology and in psychosomatic medicine itself impede an early diagnosis and treatment initiation. Practitioners in psychosomatic medicine are faced with the new diagnosis of “Somatic Symptom Disorder” in DSM-5 [8] and the suggested “Bodily Distress Disorder” in ICD-11 [9,10] which both no longer exclude the existence of underlying medical conditions. Etiological concepts of persistent somatic symptoms differ substantially between medical specialties. The lack of medical guidelines or specialized treatment options for persistent somatic symptoms in some European countries present additional challenges for practitioners and affected patients [11,12]. Available clinical guidelines (e.g., from Germany or the Netherlands) suggest a stepped-care approach for patients with persistent somatic symptoms [13,14] which often remains unimplemented in favor of medication use actually intended for the treatment of anxiety, depression, and other mental health problems [15]. Given that research efforts on persistent somatic symptoms would largely benefit from a more coordinated and collaborative approach across Europe, we have come to recognize the urgent need to establish a European research network. By bringing researchers from all over Europe to take a seat at the table, we sought to develop a joint research agenda to address the pressing needs for improvement in the recognition, diagnosis, explanation and treatment of patients with persistent somatic symptoms.

Aggregating factors of the change process in the treatment of anorexia nervosa

PURPOSE We aimed to reduce the large body of factors which may be associated with the change process in treatments for Anorexia Nervosa (AN) into a clinically and scientifically useful number of higher-rank dimensions. In addition, we examined the associations between the identified factors and eating disorder psychopathology and body mass index (BMI) in exploratory analyses. METHODS Within a naturalistic multicenter study we administered the Change Process Questionnaire (CPQ-AN) to inpatients with AN upon admission. The factorial structure of the CPQ-AN was explored via factor analysis. Multiple regression analyses were performed to examine the associations with BMI and eating disorder symptomatology (EDI-2). RESULTS In total 233 female inpatients with AN (mean BMI=14.9 kg/m(2), SD=1.7) participated. The factor analysis yielded four latent factors: basic need satisfaction, AN-specific cognitions and behavior, emotional involvement and commitment to treatment, and alliance and treatment confidence. Furthermore, greater basic need satisfaction and less AN-specific cognitions and behavior predicted lower EDI-2 scores. Higher alliance and treatment confidence were associated with higher BMI as well as a lower EDI-2 score. CONCLUSION The associations between the newly derived dimensions and BMI and AN-psychopathology provide evidence to support the clinical relevance of the identified change process dimensions. Future investigations could provide further insights to deepen our understanding of the change process in AN.

Stellenwert von Kurzinterventionen in der Versorgungskette von Essstörungen

So far there is no comprehensive overview on brief outpatient interventions in eating disorders. The specific relevance of psychotherapeutic brief interventions for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder is presented against the background of current healthcare supply chains. This review is based on a literature search that evaluated relevant publications in applicable literature databases. The articles were excerpted and are presented in a narrative overview. In summary, the literature shows a marginal expansion of healthcare provision towards personnel-efficient and cost economic therapeutic solutions for Bulimia Nervosa and Binge Eating Disorder, while the treatment of Anorexia Nervosa is currently determined by more in- and extensive approaches.

The psychenet public health intervention for anorexia nervosa: a pre-post-evaluation study in a female patient sample

Aim This non-randomized pre-post-intervention study investigated the effect of a systemic public health intervention on the length of time between anorexia nervosa symptom onset and contact with the health care system as well as the initiation of treatment. BACKGROUND Although systemic public health interventions have successfully been implemented in physical and mental health fields, their effect on the early treatment of patients with anorexia nervosa remains unclear. METHODS In total, 59 anorexia nervosa patients (mean age=21.5 years, SD=7.2) were recruited before a systemic public health intervention, and 18 patients (mean age=22.2 years, SD=8.9) were recruited afterwards. Using validated self-report measures and a semi-structured interview, the duration of untreated anorexia nervosa and the duration until first contact with the health care system were investigated. Findings At the beginning of the individual treatment initiation process, participants in both samples most frequently consulted their general practitioner or paediatrician about their eating disorder-related symptoms. Neither the mean duration of untreated anorexia nervosa, that is, the time between illness onset and the initiation of a recommended treatment, nor the duration until first contact with the health care system significantly decreased after the implementation of the systemic public health intervention. The mean duration of untreated anorexia nervosa was 36.5 months (SD=68.2) before the systemic public health intervention and 40.1 months (SD=89.4) after the implementation of the systemic public health intervention. The mean duration until first contact with the health care system was 25.0 months (SD=53.0) before the intervention and 32.8 months (SD=86.5) after the intervention. CONCLUSION Primary care providers are crucial to the treatment initiation process and should be involved in future interventions to improve early detection and treatment commencement amongst patients with anorexia nervosa.