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Clinical effectiveness of treatments for anorexia nervosa in adolescents

Randomised controlled trial

Section of Adolescent Psychiatry, University of Liverpool

ANDREW CLARK, FRCPsych

Bolton Salford and Trafford Mental Health NHS Trust

CHRIS ROBERTS, PhD

Biostatistics Group, Division of Epidemiology and Health Sciences, University of Manchester

ALISON GRIFFITHS, BA

Section of Adolescent Psychiatry, University of Liverpool

VANESSA EDWARDS, BA

Peninsula College of Medicine and Dentistry, Exeter

CLAUDINE BRYAN, BSc and NICOLA SMETHURST, BA

Section of Adolescent Psychiatry, University of Liverpool

SARAH BYFORD, MSc and BARBARA BARRETT, MSc

Kings College London, UK

Correspondence: Professor S. G. Gowers, Academic Unit, Section of Adolescent Psychiatry, University of Liverpool, Chester CH2 1AW, UK. Email: simon.gowers{at}cwpnt.nhs.uk

Declaration of Interest None. Funding detailed in Acknowledgements.

See pp. 436–440, this issue.

Background Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa.

Aims To evaluate the effectiveness of three readily available National Health Service treatments for adolescents (aged 12–18 years) with anorexia nervosa.

Method Multicentre randomised controlled trial of 167 young people comparing in-patient, specialist out-patient and general child and adolescent mental health service (CAMHS) treatment.

Results Each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat, although some CAMHS out-patients were subsequently admitted on clinical grounds. In-patient treatment (randomised or after out-patient transfer) predicted poor outcomes.

Conclusions First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.

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SUKHWINDER S. SHERGILL
BJP 2007 191: 373-a17-373. [Full Text]  

Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents

SARAH BYFORD, BARBARA BARRETT, CHRIS ROBERTS, ANDREW CLARK, VANESSA EDWARDS, NICOLA SMETHURST, and SIMON G. GOWERS
BJP 2007 191: 436-440. [Abstract] [Full Text]  

PETER TYRER
BJP 2007 191: 470. [Full Text]  

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				S G Gowers Management of eating disorders in children and adolescents Arch. Dis. Child., April 1, 2008; 93(4): 331 - 334. [Abstract] [Full Text] [PDF]

				S. BYFORD, B. BARRETT, C. ROBERTS, A. CLARK, V. EDWARDS, N. SMETHURST, and S. G. GOWERS Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents The British Journal of Psychiatry, November 1, 2007; 191(5): 436 - 440. [Abstract] [Full Text] [PDF]

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