Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study.

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.

Decreased immune response in alexithymic women: a cross-sectional study.

It has been reported in a few studies that alexithymia is associated with impaired immune response but results are still contradictory. The present study investigates whether alexithymia is associated with lower cell-mediated (Th-1) immune response. Fifty-one healthy 18-27-year-old women were selected from healthy subjects on the basis of high or low cut-off scores on the 20-item Toronto Alexithymia Scale (TAS-20). They were evaluated using standardized psychiatric rating scales notably the Hospital Anxiety Depressive Scale (HAD) and the Mini Neuropsychiatric Interview (MINI). None of the subjects were suffering from psychiatric disorders. Twenty-seven were classified as alexithymics and 24 as non-alexithymics according to the TAS-20. Blood was drawn for lymphocyte subset counts (CD4, CD8), in vitro production of interleukin 1 (IL-1beta), IL-2, IL-4, and IL-10 by phytohaemagglutinin stimulated peripheral lymphocytes, and cortisol. Women with alexithymia exhibited decreased interleukin 1beta, IL-2 and IL-4 production with reduced ratios of Th1/Th2 (IL-2/IL-10) and of CD4/CD8, as well as reduced CD4 percentages. IL-2 and IL-4 production remained significantly diminished in the alexithymic group, even after adjusting for between-group differences in anxiety and depression levels on the HAD. This study further demonstrates that alexithymic women have altered immune function, with a predominance of depressed cell-mediated immunity and a skewed Th1/Th2 ratio towards Th2 response.

Multimethod alexithymia assessment in adolescents and young adults with a cannabis use disorder.

The value of alexithymia assessments in medical and psychiatric research is well documented, but such assessments in cannabis abusers are scarce. Moreover, despite repeated calls for multimethod alexithymia evaluations, researchers typically use 1 self-report only: the 20-item Toronto Alexithymia Scale. Herein, we evaluated (1) the psychometric properties of the Observer Alexithymia Scale (OAS), (2) the correspondence between 3 alexithymia measures, (3) OAS raters' affect and its relationship to OAS scores, and (4) cannabis abusers' alexithymic features. Eighty-seven cannabis abusers completed self-reports measuring alexithymia (Toronto Alexithymia Scale, Bermond-Vorst Alexithymia Questionnaire-B), depression (13-item Beck Depression Inventory), and anxiety (State and Trait Anxiety Inventory-Form Y) and asked relatives to rate them using the OAS. The raters also completed the self-report scales. The OAS met acceptable reliability and validity standards, with the exception of relatively low interrater reliability for one of its subscales. Rater affect appeared to influence OAS scores, albeit slightly. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. Alexithymia rates were similar to those previously reported in cannabis abusers. Our results demonstrated the adequacy and appropriateness of the OAS in these (and related) clinical samples, which may encourage multimethod alexithymia assessments in both research and clinical practice.