- Email: [email protected]
3.6 Neurobiology and Genetics of Eating Disorders
INSTITUTES 3.4 – 3.6
Results: Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. By using the most recent methodological review criteria of the American Psychological Association, familybased treatment (FBT) is the only well-established treatment for adolescents with anorexia nervosa. Systemic family treatment and insight-oriented individual psychotherapy (IOP) are probably efficacious treatments for adolescents with anorexia nervosa. FBT is the only well-established treatment for adolescents with bulimia nervosa. There are no well-established treatments for binge-eating disorder or avoidant-restrictive food intake disorder. Efficacious psychosocial treatments for adolescent bulimia nervosa may include supportive individual therapy. Internet-delivered cognitive behavioral therapy is possibly an efficacious treatment for binge-eating disorder. Experimental treatments for adolescent-eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. Conclusions: FBT is the only well-established treatment for adolescenteating disorders. Additional research examining treatment for eating disorders in youth is warranted.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.024
3.4 WHEN NUTRITION AND THERAPY AREN’T ENOUGH: USE OF PSYCHOTROPIC MEDICATIONS IN THE TREATMENT OF EATING DISORDERS Jennifer L. Derenne, MD, Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94304 Objectives: Eating disorders are challenging to treat. Evidence-based interventions are psychosocial, but psychotropic medications are used in many cases. Participants in this Institute will learn about the following: 1) the medications with the FDA indications for treatment of eating disorders in children, adolescents, and young adults; 2) the data available to date on the use of psychotropic medications in this population (including antidepressants, atypical antipsychotic drugs, and mood stabilizers); 3) comorbid conditions that may warrant the use of psychotropic medications (mood, anxiety, etc.); and 4) practical guidelines for choosing medications, dosing, and monitoring potential adverse effects, with a special focus on medical complications that are unique to this patient population. Methods: The presenter will use PowerPoint to share didactic information on the evidence available thus far to support psychotropic medication use in anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/ restrictive food intake disorder. Questions from the audience and discussion will be encouraged. Results: Attendees will be more knowledgeable about the utility of using medications in this challenging population and will have practical tools at their disposal for initiating and/or maintaining psychotropic drugs when they are likely to be effective. Further, they will be well versed in potential adverse effects and the need for laboratory and cardiac monitoring in patients suffering from the effects of malnutrition. Conclusions: CAPs may be asked to see patients with eating disorders, so it is imperative that they understand the needs and unique vulnerabilities of this challenging and medically compromised population.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.025
3.5 INTEGRATING HIGHER LEVELS OF CARE AS AN EFFECTIVE COMPONENT IN TREATING CHILDREN AND ADOLESCENTS WITH EATING DISORDERS Steven F. Crawford, MD, Center for Eating Disorders at Sheppard Pratt, 6535 N. Charles Street, Towson, MD 21204 Objectives: Treatment for children and adolescents with eating disorders at a higher level of care is an essential component in a comprehensive system of eating disorder care. Effective treatment for children and adolescents with eating disorders relies on timely identification and thorough weight restoration with maintenance. Weight restoration in adolescents means returning the individual to expected body weight for that developmental period.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Family-based therapy (FBT) treatment models have demonstrated effectiveness in an outpatient setting, allowing families to restore normal weight and eating behaviors of patients as quickly as possible. This presentation will review the criteria that would suggest that an inpatient, residential level of care is indicated based on eating disorder symptom acuity or comorbid psychiatric features that makes treatment in a lower level of care ineffective. We will discuss how to integrate families into the treatment experience to help the patients acquire FBT principles and practice skills in order to continue the FBT model of care with momentum when they return home. Methods: The presenter will highlight the evidence available thus far to support best practices with respect to inpatient, residential, partial hospital, and intensive outpatient programs for children and adolescents with eating disorders. Attendees will be provided opportunities to discuss specific treatment strategies and techniques in managing eating disorder symptoms, which is difficult to do as an outpatient, and to discuss strategies to partner with higher levels of care for more successful integration of children and adolescents to the home environment. Results: Attendees will be more knowledgeable about the benefits of using higher levels of care for treating eating disorders in young people and about collaborative relationships with these treatment programs. Conclusions: Understanding how to select appropriate higher levels of care and what to expect from treatment provided by those facilities will augment the community psychiatrists’ ability to effectively treat these patients.
EA TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.026
3.6 NEUROBIOLOGY AND GENETICS OF EATING DISORDERS Guido K. Frank, MD, Psychiatry, University of Colorado Denver, The Children’s Hospital, A036/B130, 13123 E. 16th Ave, Aurora, CO 80045 Objectives: The EDs anorexia nervosa, bulimia nervosa, and binge-eating disorder are considered complex psychiatric disorders, and their etiology has been attributed to a combination of biological, psychological, and social factors. The goal of this presentation is to provide a review of and update on neurobiological research in EDs. Methods: Here, we will review past studies in EDs using neuroimaging techniques as well as genetic studies. Research that used brain imaging on brain structure and function will be reviewed, as well as positron emission tomography research for neuroreceptor studies. Genetic linkage and genome-wide association studies will be discussed, as well as recent studies on epigenetic mechanisms. Further, this presentation will provide an update on the latest neurobiological and brain research studies in EDs. Results: Neurobiological research in EDs suggests that specific brain circuits are associated with ED behaviors. Regions such as insula and orbitofrontal cortex that are associated with taste and reward processing may be altered in volume in EDs. Furthermore, eating pathology itself alters brain structure and function, and those changes may have important implications for disease progress and recovery. Individuals with EDs have been found to be highly sensitive to salient stimuli, and accordingly, functional brain-imaging research has repeatedly implicated brain reward pathways in this population. Recent studies also suggest that brain dopamine circuits could be altered across EDs, and this system could become a treatment target. Another new focus in ED research has been brain white matter function, and it appears that there is a dynamic process of white matter fiber development in the process of recovery. EDs run in families, and genetic studies that aim to identify underlying genotype are ongoing; however, progress is more incremental, and larger sample groups are still needed. Conclusions: There is a growing body of literature that has identified specific brain regions and circuits as part of ED psychopathology. Such a better understanding is important as it reduces fear and guilt of the parents of children and adolescents with EDs and helps engage the families in the treatment process. This research will also help develop disorder-specific interventions.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.027
www.jaacap.org
S89
Results: Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. By using the most recent methodological review criteria of the American Psychological Association, familybased treatment (FBT) is the only well-established treatment for adolescents with anorexia nervosa. Systemic family treatment and insight-oriented individual psychotherapy (IOP) are probably efficacious treatments for adolescents with anorexia nervosa. FBT is the only well-established treatment for adolescents with bulimia nervosa. There are no well-established treatments for binge-eating disorder or avoidant-restrictive food intake disorder. Efficacious psychosocial treatments for adolescent bulimia nervosa may include supportive individual therapy. Internet-delivered cognitive behavioral therapy is possibly an efficacious treatment for binge-eating disorder. Experimental treatments for adolescent-eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. Conclusions: FBT is the only well-established treatment for adolescenteating disorders. Additional research examining treatment for eating disorders in youth is warranted.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.024
3.4 WHEN NUTRITION AND THERAPY AREN’T ENOUGH: USE OF PSYCHOTROPIC MEDICATIONS IN THE TREATMENT OF EATING DISORDERS Jennifer L. Derenne, MD, Psychiatry, Stanford University, 401 Quarry Road, Stanford, CA 94304 Objectives: Eating disorders are challenging to treat. Evidence-based interventions are psychosocial, but psychotropic medications are used in many cases. Participants in this Institute will learn about the following: 1) the medications with the FDA indications for treatment of eating disorders in children, adolescents, and young adults; 2) the data available to date on the use of psychotropic medications in this population (including antidepressants, atypical antipsychotic drugs, and mood stabilizers); 3) comorbid conditions that may warrant the use of psychotropic medications (mood, anxiety, etc.); and 4) practical guidelines for choosing medications, dosing, and monitoring potential adverse effects, with a special focus on medical complications that are unique to this patient population. Methods: The presenter will use PowerPoint to share didactic information on the evidence available thus far to support psychotropic medication use in anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/ restrictive food intake disorder. Questions from the audience and discussion will be encouraged. Results: Attendees will be more knowledgeable about the utility of using medications in this challenging population and will have practical tools at their disposal for initiating and/or maintaining psychotropic drugs when they are likely to be effective. Further, they will be well versed in potential adverse effects and the need for laboratory and cardiac monitoring in patients suffering from the effects of malnutrition. Conclusions: CAPs may be asked to see patients with eating disorders, so it is imperative that they understand the needs and unique vulnerabilities of this challenging and medically compromised population.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.025
3.5 INTEGRATING HIGHER LEVELS OF CARE AS AN EFFECTIVE COMPONENT IN TREATING CHILDREN AND ADOLESCENTS WITH EATING DISORDERS Steven F. Crawford, MD, Center for Eating Disorders at Sheppard Pratt, 6535 N. Charles Street, Towson, MD 21204 Objectives: Treatment for children and adolescents with eating disorders at a higher level of care is an essential component in a comprehensive system of eating disorder care. Effective treatment for children and adolescents with eating disorders relies on timely identification and thorough weight restoration with maintenance. Weight restoration in adolescents means returning the individual to expected body weight for that developmental period.
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
Family-based therapy (FBT) treatment models have demonstrated effectiveness in an outpatient setting, allowing families to restore normal weight and eating behaviors of patients as quickly as possible. This presentation will review the criteria that would suggest that an inpatient, residential level of care is indicated based on eating disorder symptom acuity or comorbid psychiatric features that makes treatment in a lower level of care ineffective. We will discuss how to integrate families into the treatment experience to help the patients acquire FBT principles and practice skills in order to continue the FBT model of care with momentum when they return home. Methods: The presenter will highlight the evidence available thus far to support best practices with respect to inpatient, residential, partial hospital, and intensive outpatient programs for children and adolescents with eating disorders. Attendees will be provided opportunities to discuss specific treatment strategies and techniques in managing eating disorder symptoms, which is difficult to do as an outpatient, and to discuss strategies to partner with higher levels of care for more successful integration of children and adolescents to the home environment. Results: Attendees will be more knowledgeable about the benefits of using higher levels of care for treating eating disorders in young people and about collaborative relationships with these treatment programs. Conclusions: Understanding how to select appropriate higher levels of care and what to expect from treatment provided by those facilities will augment the community psychiatrists’ ability to effectively treat these patients.
EA TREAT http://dx.doi.org/10.1016/j.jaac.2016.07.026
3.6 NEUROBIOLOGY AND GENETICS OF EATING DISORDERS Guido K. Frank, MD, Psychiatry, University of Colorado Denver, The Children’s Hospital, A036/B130, 13123 E. 16th Ave, Aurora, CO 80045 Objectives: The EDs anorexia nervosa, bulimia nervosa, and binge-eating disorder are considered complex psychiatric disorders, and their etiology has been attributed to a combination of biological, psychological, and social factors. The goal of this presentation is to provide a review of and update on neurobiological research in EDs. Methods: Here, we will review past studies in EDs using neuroimaging techniques as well as genetic studies. Research that used brain imaging on brain structure and function will be reviewed, as well as positron emission tomography research for neuroreceptor studies. Genetic linkage and genome-wide association studies will be discussed, as well as recent studies on epigenetic mechanisms. Further, this presentation will provide an update on the latest neurobiological and brain research studies in EDs. Results: Neurobiological research in EDs suggests that specific brain circuits are associated with ED behaviors. Regions such as insula and orbitofrontal cortex that are associated with taste and reward processing may be altered in volume in EDs. Furthermore, eating pathology itself alters brain structure and function, and those changes may have important implications for disease progress and recovery. Individuals with EDs have been found to be highly sensitive to salient stimuli, and accordingly, functional brain-imaging research has repeatedly implicated brain reward pathways in this population. Recent studies also suggest that brain dopamine circuits could be altered across EDs, and this system could become a treatment target. Another new focus in ED research has been brain white matter function, and it appears that there is a dynamic process of white matter fiber development in the process of recovery. EDs run in families, and genetic studies that aim to identify underlying genotype are ongoing; however, progress is more incremental, and larger sample groups are still needed. Conclusions: There is a growing body of literature that has identified specific brain regions and circuits as part of ED psychopathology. Such a better understanding is important as it reduces fear and guilt of the parents of children and adolescents with EDs and helps engage the families in the treatment process. This research will also help develop disorder-specific interventions.
EA http://dx.doi.org/10.1016/j.jaac.2016.07.027
www.jaacap.org
S89