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Intensive Treatments in Adolescent Anorexia Nervosa.
Herpertz-Dahlmann, B
Nutrients. 2021;(4)
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
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Developments in the psychological treatment of anorexia nervosa and their implications for daily practice.
Jansingh, A, Danner, UN, Hoek, HW, van Elburg, AA
Current opinion in psychiatry. 2020;(6):534-541
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Abstract
PURPOSE OF REVIEW Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice. RECENT FINDINGS Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results. SUMMARY For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.
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Current and Future Treatments in Alzheimer's Disease.
Atri, A
Seminars in neurology. 2019;(2):227-240
Abstract
The foundation of current Alzheimer's disease (AD) treatment involves pharmacological and nonpharmacological management and care planning predicated on patient-centered psychoeducation, shared goal-setting, and decision-making forged by a strong triadic relationship between clinician and the patient-caregiver dyad. Food and Drug Administration (FDA) approved AD medications, cholinesterase-inhibitors (ChEIs), and the N-methyl-d-aspartate (NMDA) antagonist memantine, when utilized as part of a comprehensive care plan, while generally considered symptomatic medications, can provide modest "disease course-modifying" effects by enhancing cognition, and reducing loss of independence. When combined, pharmacologic and nonpharmacologic treatments can meaningfully mitigate symptoms and reduce clinical progression and care burden. AD pharmacotherapy first involves identification and elimination of potentially harmful medications and supplements. First line treatment for neuropsychiatric symptoms and problem behaviors is nonpharmacological and involves psychoeducation, trigger identification, and implementation, iterative evaluation, and adjustment of behavioral and environmental interventions. Intensive research efforts are underway to develop more accurate and practical AD diagnostic biomarkers and clinical tools and better therapeutics. Ongoing research studies for primary and secondary prevention of AD and clinical trials evaluating symptomatic and disease-modifying treatments in symptomatic AD are directed at diverse therapeutic targets including neurochemicals, amyloid and tau pathological processes, mitochondria, inflammatory pathways, neuroglia, and multimodal lifestyle interventions.
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Psychological therapies for chronic widespread pain and fibromyalgia syndrome.
Häuser, W, Jones, G
Best practice & research. Clinical rheumatology. 2019;(3):101416
Abstract
Psychological factors such as adverse childhood experiences, traumatic life events, interpersonal conflicts and psychological distress play an important role in the predisposition, onset and severity of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Therefore, psychological therapies might have the potential to reduce disability as well as symptom and economic burden in patients with CWP and FMS. Recent interdisciplinary guidelines have suggested different strengths of recommendation for psychological therapies for FMS. The aims of this narrative review are to summarise: • Mechanisms of actions. • Evidence on efficacy, tolerability and safety. • Knowledge gaps and needs for future research of psychological therapies for CWP and FMS for non-mental health professionals.
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[Implicit Self-Regulation of Food-Intake: Consequences for Psychotherapy].
Paslakis, G, de Zwaan, M
Psychotherapie, Psychosomatik, medizinische Psychologie. 2019;(11):453-461
Abstract
Explicit processes of self-regulation require insight and control during implementation and are therefore often experienced as being strenuous, while implicit processes of steering behavior are automatic, rapid and effortless. However, self-regulation is not always either explicit or implicit; all variants ranging from those that are entirely automatic to those being entirely under control are present. As individuals are not aware of their underlying implicit modes of self-regulation, it is necessary to create an approach that is proximal to affective processing, by-passing the cognitive, verbal level. Promising approaches of this kind are such including embodied experiences or such shifting the body to a state, in which the apperception of implicit mechanisms is facilitated. Given that therapeutic work of self-regulation is in many cases carried out on an explicit level of processing, the need for novel, neurobiologically founded strategies intervening on the implicit (pre-verbal) level are called for. Correspondent paradigms, e. g. the approach-avoidance task (AAT) for the assessment of implicit processes are presented here with regard to food-intake regulation. This work is a narrative (qualitative) review aiming at illustrating the field of implicit bias research as well as the development of new implicit bias training paradigms to be used as add-on in future psychotherapeutic treatments. Therefore, a selection of relevant studies based on subjective criteria was made. Thus, this work is not a systematic review and does not claim to be an exhaustive description of studies of this kind.
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[The Role of Psychotherapy in the Treatment of Irritable Bowel Syndrome].
Weibert, E, Stengel, A
Psychotherapie, Psychosomatik, medizinische Psychologie. 2019;(9-10):360-371
Abstract
Irritable bowel syndrome is a common functional gastrointestinal disorder that greatly impacts on quality of life due to gastrointestinal complaints such as pain or altered stool habits. Based on the biopsychosocial model the severity of the disease is affected by the combination of physiological processes, social aspects and psychological factors. While treatment approaches mainly focused on the reduction of gut complaints by dietary means or medication, psychotherapy is becoming an alternative or additional approach with very good evidence, especially in light of associated psychiatric comorbidities (e. g. depression, anxiety disorder). Often psychiatric symptoms/comorbidities increase the probability of a complicated course of the disease with a reciprocal interaction of gut complaints and psychiatric symptoms. Behavioral therapy, psychodynamic psychotherapy, hypnotherapy, mindfulness interventions and other psychotherapeutic methods are used to increase coping as well as disease control and to restructure dysregulated cognitive processes. The current review focuses on psychosocial aspects of the irritable bowel syndrome and discusses the benefit of psychotherapeutic interventions.