Brian Kay

Clinical Observations of the Impact of Maudsley Therapy in Improving Eating Disorder Symptoms, Weight, and Depression in Adolescents Receiving Treatment for Anorexia Nervosa

This article describes a comparison of adolescent patients with a diagnosis of anorexia nervosa receiving treatment with and without family-based therapy. Sixteen patients with anorexia nervosa were evaluated and compared pretreatment and post-treatment. The family-based program used is an adaptation of the Maudsley approach; a parallel treatment program used the standard multidisciplinary treatment at Rogers Memorial Hospital. The outcome measures in both programs were depression, eating disorder symptoms, weight, and body mass index. Individuals treated with the Maudsley approach made significant improvements in all outcomes measured. These preliminary findings support the notion that parental involvement in the treatment of anorexia nervosa is effective in significantly reducing overall eating disorder behaviors, decreasing symptoms of depression, and improving weight.

Recidivism Risk of Repeat Intoxicated Drivers Monitored with Alcohol Biomarkers

This feasibility study analyzed the effects of alcohol biomarker testing in reducing the rearrest rates and/or lengthening the time between rearrests in repeat intoxicated drivers in Waukesha County. Participants were 250 repeat offenders who underwent monitoring with biomarker testing after being arrested for driving under the influence (DUI) of alcohol between 2006 and 2009. In 2012, their traffic records were reviewed to determine any subsequent drunk driving arrests since their assessments in 2006 to 2009. Regression analysis was used to determine the relationship between the length of biomarker monitoring (LOM) and the time to recidivism (TTR). LOM was defined as the time between the offenders first test at enrollment in this study (baseline Early Detection of Alcohol Consumption [EDAC]) and the last test at the end of monitoring. TTR was defined as the length of time from baseline EDAC until the drivers next subsequent DUI offense. The results showed that 32 of the 250 drivers enrolled in this pilot were rearrested during the study period for an overall recidivism rate of 12.8%. The rearrested drivers were mostly men (88%), young adults (34 years), employed (84%), and predominantly single or divorced (86%). Their drinking profile at baseline showed that 93% claimed at least one month of abstinence before their first sample was collected yet almost one half (48%) of them tested positive for biomarkers. Regression analysis showed a positive and significant correlation between LOM and TTR (r = 0.41; p < 0.05; coefficient for LOM = 1.28; N = 23) indicating that for every additional day of biomarker monitoring the time to re-arrest increased by more than one day. This feasibility study provides preliminary evidence suggesting that repeat DUI offenders monitored with alcohol biomarkers take longer to get rearrested with a subsequent DUI than those not monitored with biomarkers.

An Initial Case Series of Intensive Cognitive–Behavioral Therapy for Obsessive–Compulsive Disorder in Adolescents with Autism Spectrum Disorder

Obsessive–compulsive disorder (OCD) is prevalent among youth with autism spectrum disorder (ASD). Cognitive–behavioral therapy (CBT) with ASD-specific modifications has support for treating OCD in this population; however, use of intensive CBT in youth with ASD and severe OCD has not been tested. The current study examined the preliminary effectiveness of an individualized intensive CBT protocol for OCD in adolescents with ASD. Nine adolescents (aged 11–17 years) completed a regimen of intensive CBT (range 24–80 daily sessions) incorporating exposure with response prevention (ERP). Treatment materials, language and techniques were modified in accordance with evidence-based findings for this population. Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35–2.58) were obtained on primary outcomes (e.g., obsessive–compulsive symptom severity). Preliminary findings suggest that an intensive CBT approach for OCD is effective among adolescents with ASD.

Symptom correspondence between clinicians and patients on the Yale-Brown Obsessive Compulsive Scale.

The present study examined concordance between the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and its self-report version (Y-BOCS-SR), as well as theoretically derived moderators. Sixty-seven adults (ages 18-67) with obsessive-compulsive disorder (OCD) were administered the Y-BOCS prior to completing self-report measures. The Y-BOCS-SR generated lower scores relative to the clinician-administered Y-BOCS (5.3 points lower). Strong correspondence was shown between the Y-BOCS and Y-BOCS-SR; however, many items exhibited fair to moderate agreement, particularly the resistance and control against obsessions/compulsions items. Depression significantly moderated correspondence such that Y-BOCS-SR scores significantly predicted Y-BOCS scores in the presence of low and average depression levels in our sample, but not for patients with high levels of depression relative to the rest of our sample; gender, generalized anxiety and obsessionality did not significantly impact agreement. Synthesizing the present data, the Y-BOCS-SR demonstrates modest agreement with the Y-BOCS and may underestimate clinical severity especially for those with high levels of depression.

Long-Term Effects of a Multidisciplinary Residential Treatment Model on Improvements of Symptoms and Weight in Adolescents With Eating Disorders

This report describes a multidisciplinary residential treatment approach for adolescents with eating disorders. It presents data on treatment efficacy and analyzes long term follow-up results focusing on nutritional and behavioral interventions delivered in a systematic residential setting. Residents were evaluated at admission, discharge, and follow-up (M=24 months post-discharge) using a panel of well-established psychological measures (EDE-Q, BDI, YBOC, STAI). The results showed both statistically and clinically significant reductions in eating disorder symptomology between admission and discharge. At the end of residential treatment, symptoms of anxiety, depression and obsessive compulsive behaviors had decreased to within the norms of non-diseased populations, and there was little regression from discharge to follow-up. Weight gains were also sustained after discharge. These results indicate that a multidisciplinary model to treat eating disorders in a residential setting is an effective approach to treat these disorders and further supports the need to grow residential care in behavioral health settings.

Gender differences in eating disorder psychopathology across DSM-5 severity categories of anorexia nervosa and bulimia nervosa

OBJECTIVE This study examined whether patterns of eating-disorder (ED) psychopathology differed by gender across DSM-5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN). METHOD We tested whether ED psychopathology differed across DSM-5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN. RESULTS Among females with BN, DSM-5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination-Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM-5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels. DISCUSSION Results demonstrate that DSM-5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM-5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM-5 severity categories (e.g., chronicity, treatment non-response), and consider alternate classification schemes.