Two‐year follow‐up of the MOSAIC trial: A multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa

Schmidt, Ulrike; Ryan, Elizabeth G.; Bartholdy, Savani; Renwick, Bethany; Keyes, Alexandra; O’Hara, Caitlin B; McClelland, Jessica; Lose, Anna; Kenyon, Martha; DeJong, Hannah; Broadbent, Hannah; Loomes, Rachel; Serpell, Lucy; Richards, Lorna; Johnson‐Sabine, Eric; Boughton, Nicky; Whitehead, Linette; Bonin, Eva-Maria; Beecham, Jennifer; Landau, Sabine; Treasure, Janet

doi:10.1002/eat.22523

Cited by 61 publications

(51 citation statements)

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“…Moreover, the percentage of individuals with scores below the clinical cut off of the EDE‐Q (<2.8) increased from 18% at the start of treatment to 70% at 12 months after starting of treatment. These findings are comparable to those found under optimal conditions in recent research cohorts and large‐scale clinical trials, such as the UK‐Italy study of enhanced cognitive behavioural therapy in AN and the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions . Similar improvements in the FREED cohort were observed across all other clinical outcomes including depression, anxiety and stress, global distress and functioning, work and social adjustment, and expressed emotion.…”

Section: Discussionsupporting

confidence: 84%

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A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

McClelland

Hodsoll

Brown

et al. 2018

Euro Eating Disorders Rev

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This pilot study assesses the impact of FREED (First Episode Rapid Early Intervention for Eating Disorders [ED]), a novel transdiagnostic service for emerging adults with recent ED onset, on clinical outcomes. Data were collected from 56 patients and 19 carers for 12 months following enrolment. FREED patients showed significant improvements in ED and other symptoms across time. Carers also showed psychological improvements. For FREED anorexia nervosa (AN) patients, body mass index (BMI) at initial clinical assessment was similar to that of comparable patients (audit cohort) seen in our service before (16.4 vs 16.1 kg/m ). By start of treatment, because of their shorter wait, FREED-AN had gained weight whereas audit patients had lost (16.7 vs 15.8 kg/m ). This difference continued throughout treatment, and at 12 months, nearly 60% FREED-AN patients returned to a BMI of 18.5 or greater. FREED shows promise as a service model for emerging adults with EDs.

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Section: Discussionsupporting

confidence: 84%

“…For young people with AN, individual outpatient therapy using the Maudsley Model of Anorexia Nervosa Treatment, a formulation‐based treatment with a patient workbook, is typically used. Treatment duration typically is 24 to 34 sessions . Sessions with family members/carers are an integral part of treatment.…”

Section: Methodsmentioning

confidence: 99%

A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

McClelland

Hodsoll

Brown

et al. 2018

Euro Eating Disorders Rev

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“…higher than the BMI increase typically seen in trials of adults with AN, which include many patients with long-standing or relapsing forms of illness (Byrne et al, 2017;Schmidt et al, 2015;Schmidt et al, 2016, b, c).…”

Section: Discussionmentioning

confidence: 81%

First episode rapid early intervention for eating disorders: A two‐year follow‐up

Fukutomi

Austin

McClelland

et al. 2019

Early Intervention Psych

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Aim: We describe 2-year outcomes of a novel first episode early intervention service for young adults with a recent onset eating disorder (FREED).Outcomes in FREED patients with anorexia nervosa (AN) were compared with those from patients previously seen in our service [treatment as usual (TAU) cohort], matched for age, illness duration and diagnosis. Methods: Electronic case records of FREED-AN (n = 22) and TAU-AN patients (n = 35) were examined to identify service utilisation and clinical outcomes over 24 months. Results: Outpatient service utilisation was similar in both groups, but FREED-AN patients needed intensive (in-or day-patient) treatment less frequently than TAU-AN (23% vs 32%). FREED-AN patients had a higher estimated mean body mass index [19.2 kg/m 2 ; 95% CI (18.21, 20.16)] than TAU patients [18.0 kg/m 2 ; 95% CI (16.90, 19.15)] at last contact.

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“…We have completed a 2-year follow-up of the MOSAIC patients, showing that improvements across clinical outcomes are maintained or increase further. 161 …”

Section: Conclusion and Future Outlookmentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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Two‐year follow‐up of the MOSAIC trial: A multicenter randomized controlled trial comparing two psychological treatments in adult outpatients with broadly defined anorexia nervosa

Abstract: Both treatments have value as outpatient interventions for patients with AN. © 2016 Crown copyright. International Journal of Eating Disorders. (Int J Eat Disord 2016; 49:793-800).

Cited by 61 publications

References 26 publications

A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

A pilot evaluation of a novel First Episode and Rapid Early Intervention service for Eating Disorders (FREED)

First episode rapid early intervention for eating disorders: A two‐year follow‐up

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

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