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Garda VR, Italy

Dalle Grave R.,Villa Garda Hospital
European Journal of Internal Medicine

Background: Eating disorders are common health problems afflicting mainly female adolescents and young women. They are associated with important physical health and psychosocial morbidity, and carry increased risk of death. Their cause is not yet completely understood and their management is complex, with some patients resisting all available treatments. Aims of this review: To provide the readers with an update regarding our knowledge and understanding of eating disorders. Methods: Medline database has been used for searching articles on eating disorders published since 1980. The key words used were eating disorders, anorexia nervosa, bulimia nervosa, bulimia, and binge eating. Professional books published during this period has been also reviewed. Conclusions: In the last 30 years a substantial improvement has been achieved both in the understanding and management of eating disorders, but many problems still need to be resolved. Three principal priorities should be addressed. First, the actual classification of eating disorders should be revised, since about half the cases seen in clinical practice receive a diagnosis of eating disorder not otherwise specified, and it is common to observe a migration between eating disorder diagnoses. Second, the research on pathogenesis should better clarify the exact role of genetic and environmental risk factors, and how they interact and vary across the development and maintenance of eating disorders. Third, there is an urgent need both to disseminate the few evidence-based treatments available, and to develop more potent treatments for all the eating disorder diagnostic categories. © 2010 European Federation of Internal Medicine. Source

Dalle Grave R.,Villa Garda Hospital
European Psychiatric Review

Cognitive behavioural therapy (CBT) is the most effective treatment for adults with bulimia nervosa (BN), but it is not effective enough; at best, only half of patients make a full remission and it has not been designed for treating patients with anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS). To address some of these limitations, an enhanced form of CBT for BN, named CBT-E, has been developed. CBT-E adopts modern procedures to address eating disorder psychopathology, and it is suitable for treating all forms of clinical eating disorders. The treatment was originally designed for adults in standard outpatient settings, but was then adapted for intense levels of care (e.g. intensive outpatient, day-hospital, and inpatient). In this article intensive CBT-E for treating eating disorders will be described. A brief summary of the data supporting this novel form of treatment will also be provided. © Touch Briefings 2011. Source

Fairburn C.G.,University of Oxford | Cooper Z.,University of Oxford | Doll H.A.,University of East Anglia | O'Connor M.E.,University of Oxford | And 2 more authors.
Behaviour Research and Therapy

Anorexia nervosa is difficult to treat and no treatment is supported by robust evidence. As it is uncommon, it has been recommended that new treatments should undergo extensive preliminary testing before being evaluated in randomized controlled trials. The aim of the present study was to establish the immediate and longer-term outcome following " enhanced" cognitive behaviour therapy (CBT-E). Ninety-nine adult patients with marked anorexia nervosa (body mass index ≤ 17.5) were recruited from consecutive referrals to clinics in the UK and Italy. Each was offered 40 sessions of CBT-E over 40 weeks with no concurrent treatment. Sixty-four percent of the patients were able to complete this outpatient treatment and in these patients there was a substantial increase in weight (7.47 kg, SD 4.93) and BMI (2.77, SD 1.81). Eating disorder features also improved markedly. Over the 60-week follow-up period there was little deterioration despite minimal additional treatment. These findings provide strong preliminary support for this use of CBT-E and justify its further evaluation in randomized controlled trials. As CBT-E has already been established as a treatment for bulimia nervosa and eating disorder not otherwise specified, the findings also confirm that CBT-E is transdiagnostic in its scope. © 2012 Elsevier Ltd. Source

Dalle Grave R.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | Conti M.,Villa Garda Hospital | Doll H.,University of Leicester | Fairburn C.G.,University of Oxford
Psychotherapy and Psychosomatics

Background: The aim of this study was to compare the immediate and longer-term effects of two cognitive behaviour therapy programmes for hospitalized patients with anorexia nervosa, one focused exclusively on the patients' eating disorder features and the other focused also on mood intolerance, clinical perfectionism, core low self-esteem or interpersonal difficulties. Both programmes were derived from enhanced cognitive behaviour therapy (CBT-E) for eating disorders. Methods: Eighty consecutive patients with severe anorexia nervosa were randomized to the two inpatient CBT-E programmes, both of which involved 20 weeks of treatment (13 weeks as an inpatient and 7 as a day patient). The patients were then followed up over 12 months. The assessments were made blind to treatment condition. Results: Eighty-one percent of the eligible patients accepted inpatient CBT-E, of whom 90% completed the 20 weeks of treatment. The patients in both programmes showed significant improvements in weight, eating disorder and general psychopathology. Deterioration after discharge did occur but it was not marked and it was restricted to the first 6 months. There were no statistically significant differences between the effects of the two programmes. Conclusions: These findings suggest that both versions of inpatient CBT-E are well accepted by these severely ill patients and might be a viable and promising treatment for severe anorexia nervosa. There appears to be no benefit from using the more complex form of the treatment. Copyright © 2013 S. Karger AG, Basel. Source

Grave R.D.,Villa Garda Hospital | Calugi S.,Villa Garda Hospital | El Ghoch M.,Villa Garda Hospital | Conti M.,Villa Garda Hospital | Fairburn C.G.,University of Oxford
Frontiers in Psychiatry

Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based on the enhanced cognitive behavior therapy (CBT-E). The patients were assessed before and after hospitalization, and 6 and 12 months later. Results: Twenty-six patients (96%) completed the program. In these patients, there was a substantial improvement in weight, eating disorder features, and general psychopathology that was well maintained at 12-month follow-up. Conclusion: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa. © 2014 Dalle Grave, Calugi, El Ghoch, Conti and Fairburn. Source

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