Access

In some fields of medicine, a patient and the family can expect to hear from the doctor and other clinicians a similar list of questions, and a similar list of answers. If there are choices of treatments, the patient will be offered a list of pros and cons. The decisions will be based on science, experience, and professional guidelines.

In psychiatry.... not so much.

It is really hard for a parent to know what treatment approaches are possible, available, and most likely to be helpful.

This is why I am so deeply thankful to Dr. Cynthia Bulik, one of F.E.A.S.T's Advisory Council, and to Joseph Ingram at John Wiley for the generous offer to make the following articles available to the public for six months after FEAST requested open access. I believe parents and caregivers want this kind of information and will be thankful for this opportunity.

Mr. Ingram has asked FEAST to let him know the results of this experiment - to send him feedback. It would mean a lot to me to hear from you: did you read these papers? Did they help you? Did you share them with anyone (family, friends, clinicians, teachers...)? Was there information that you didn't know, or will now use in a practical way?

Outcomes of eating disorders: A systematic review of the literature
International Journal of Eating Disorders
Volume 40, Issue 4, Date: May 2007, Pages: 293-309
Nancy D. Berkman, Kathleen N. Lohr, Cynthia M. Bulik
Full Text: PDF (184K)

Anorexia nervosa treatment: A systematic review of randomized controlled trials
International Journal of Eating Disorders
Volume 40, Issue 4, Date: May 2007, Pages: 310-320
Cynthia M. Bulik, Nancy D. Berkman, Kimberly A. Brownley, Jan A. Sedway, Kathleen N. Lohr
Full Text: PDF (140K)

Bulimia nervosa treatment: A systematic review of randomized controlled trials
International Journal of Eating Disorders
Volume 40, Issue 4, Date: May 2007, Pages: 321-336
Jennifer R. Shapiro, Nancy D. Berkman, Kimberly A. Brownley, Jan A. Sedway, Kathleen N. Lohr, Cynthia M. Bulik
Full Text: PDF (169K)

Binge eating disorder treatment: A systematic review of randomized controlled trials
International Journal of Eating Disorders
Volume 40, Issue 4, Date: May 2007, Pages: 337-348
Kimberly A. Brownley, Nancy D. Berkman, Jan A. Sedway, Kathleen N. Lohr, Cynthia M. Bulik
Full Text: PDF (138K)

Comments

  1. Laura. . .

    I read the second paper -- the review of AN treatment and found it very helpful.

    Since I am an avid reader on the topic already, it kind of confirmed what I already thought:
    1. It is difficult to compare AN studies because of differences in recovery/diagnostic/severity criteria
    2. It is difficult to gather meaningful statistics due to small sample size/high drop out rate.
    3. It is difficult to attribute positive or negative changes to the study or to variables already present in the sample group (ex. length of illness.

    Point of interest, it did say that although Maudsley therapy is helpful for adolescents, it has yet to show any meaningful improvement for adult sufferers. . .

    A

    ReplyDelete
  2. I'm so glad to know people are reading it. I think the overall lesson is: we need more good research, period. So little is really known, especially compared to what is done without backing.

    On your final point, this is clearly true. Though the fact is NOTHING is very successful with adult sufferers. That's why catching it early and treating it decisively is necessary for avoiding long-term suffering.

    There are an increasing number of people using FBT/M with older people, couples, BED - with success. But the best idea is to prevent chronic cases in the first place, right?

    ReplyDelete
  3. To put it in context -
    The longer ANY disease goes without successful treatment, the worse the expected outcomes for that person are.
    If we think of adults as, say 21yrs minimum, and the average age of onset is 15, that means that the typical adult sufferer has had this disease for at least 6 years.
    I bet if you drill down into any disease population and look at the had it unsuccessfully or un- treated 6+ years, vs had disease <6 yrs, the former group experiences more morbidity and mortality.

    ReplyDelete
  4. To put it in context -
    The longer ANY disease goes without successful treatment, the worse the expected outcomes for that person are.
    If we think of adults as, say 21yrs minimum, and the average age of onset is 15, that means that the typical adult sufferer has had this disease for at least 6 years.
    I bet if you drill down into any disease population and look at the had it unsuccessfully or un- treated 6+ years, vs had disease <6 yrs, the former group experiences more morbidity and mortality.

    ReplyDelete
  5. True true. . .

    It is also a sad review. . .

    We have nothing concrete to treat AN.

    What I would like to know, is the difference between those who recover with refeeding only and those who remain sick for long periods.

    Sometimes the same treatment produces different results regardless of admission BMI, comorbities, age of onset, etc. . .

    We need more research

    ReplyDelete
  6. Sry about the double post!

    A - the cynical part of me says that the reason there has been less research into EDs has to do with The Patricarcy dismissing a "spoiled little girls disease". No doubt, this is SOME of the problem.

    However, as a clinical researcher, I know that the paucity of good studies is also partly due to the ED population: stigma, denial, anosognosia, under-diagnosis and a pediatric population are not a promising mix for enrolling a large clinical study.

    However, the recent work showing the seriousness of EDs in terms of the morbidity, mortality, and heavily impacted quality of life for sufferers might help change this - if only we can get the word out. I take every opportunity to refer clinicians that I know to the evidence based work, but the going is always slow, it seems.

    We need to create that tipping point.

    ReplyDelete
  7. Coming late to this one, but not to cynicism I'd say that the lack of research also has something to do with the fact that very few drugs have proved to be useful with eating disorders. Most of the money for medical research comes from the drugs companies and if they're not likely to make any money they're not likely to invest much in research

    ReplyDelete

Post a Comment

Popular Posts