Treating severe and enduring anorexia nervosa: a randomized controlled trial.

BACKGROUND: There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN. METHOD: Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes. RESULTS: Thirty-one participants were randomized to CBT-AN and 32 to SSCM with a retention rate of 85% achieved at the end of the study. At EOT and follow-up, both groups showed significant improvement. There were no differences between treatment groups at EOT. At the 6-month follow-up, CBT-AN participants had higher scores on the Weissman Social Adjustment Scale (WSAS; p = 0.038) and at 12 months they had lower Eating Disorder Examination (EDE) global scores (p = 0.004) and higher readiness for recovery (p = 0.013) compared to SSCM. CONCLUSIONS: Patients with SE-AN can make meaningful improvements with both therapies. Both treatments were acceptable and high retention rates at follow-up were achieved. Between-group differences at follow-up were consistent with the nature of the treatments given.

Reperfusion of the ischemic canine myocardium: effect on vascular exchange and resistance.

In order to see if changes in hemodynamic resistance following reperfusion of ischemic myocardium could be related to alterations in microvascular exchange, we measured resistance (R), permeability surface-area for sucrose (PS), and distribution volumes for tritiated water (V) and for sucrose (VS) in nine anesthetized dogs in which blood to the left anterior descending coronary artery was supplied via a shunt from the carotid artery. Measurements were made during four periods: baseline, reduced coronary artery flow, reperfusion, and a second period of reduced flow. Increase in resistance following reperfusion (R2 = 1.8 +/- 3, R4 = 2.5 +/- .5 mmHg/min/ml, mean +/- s.e.m.) was significantly greater than in nine control dogs in which reperfusion was omitted. Also, the series of interventions including reperfusion lowered PS and V (PS4/PS1 = .54 +/- .07, V4/V1 = .58 +/- .08). Our results suggest that increases in resistance due to reperfusion may be accompanied by a loss in functioning capillary surface area.