A Randomised Control Trial Of Non-specific Clinical Management Versus CBT In Chronic Anorexia Nervosa
Funder
National Health and Medical Research Council
Funding Amount
$555,843.00
Summary
Anorexia nervosa (AN) is a serious mental illness that usually starts in adolescence and often runs a chronic course. With an estimated prevalence rate between 0.5% and 3.7% of women, and up to 50% remaining chronically ill, the illness poses a disproportionate burden on health and social services. AN has inpatient costs alone that exceed that for schizophrenia. Chronic AN has the highest mortality rate of any mental illness. Chronic AN patients are known for their ambivalence about engaging in ....Anorexia nervosa (AN) is a serious mental illness that usually starts in adolescence and often runs a chronic course. With an estimated prevalence rate between 0.5% and 3.7% of women, and up to 50% remaining chronically ill, the illness poses a disproportionate burden on health and social services. AN has inpatient costs alone that exceed that for schizophrenia. Chronic AN has the highest mortality rate of any mental illness. Chronic AN patients are known for their ambivalence about engaging in treatment and poor motivation to change their eating disorder behaviours. They often fail to respond to traditional treatments and develop a history of negative treatment experiences and repeated treatment failures. A new approach is needed to reduce both the personal suffering and the burden of the illness on social and medical services. To date, there has been little scientific investigation into the development of specific treatment for those patients with chronic AN. This study will trial a recently manualised therapy - non-specific supportive clinical management - which initial evidence suggests may hold promise for chronic AN because it offers a more indirect, motivationally-matched approach. This treatment will be compared to the establishment therapy Cognitive Behavioural Therapy. Patients will be randomly allocated to one of the two treatment conditions and will receive 40 sessions over 12 months. They will be thoroughly assessed prior to during and after they have completed treatment and followed up for 6 months. This is the worlds first trial of a psychological treatment for chronic AN; it is hoped the study will establish an effective treatment for this debilitating and expensive illness. Further, as the project aims to explore the core, but often over-looked, feature of AN - poor motivation for recovery - it will also be in a position to shed light on the deep psychological processes that maintain this illness.Read moreRead less
Human ageing is characterised by reduced appetite and food intake, so that average body weight decreases after 70-75 years. This physiological anorexia predisposes to pathological weight loss and malnutrition, worsening of other illnesses, and increased mortality. This project aims to identify causes of this anorexia of ageing, with a view to developing prevention and treatment strategies. We hypothesise that (1) Satiety signals are overactive in the elderly. We will determine whether older peop ....Human ageing is characterised by reduced appetite and food intake, so that average body weight decreases after 70-75 years. This physiological anorexia predisposes to pathological weight loss and malnutrition, worsening of other illnesses, and increased mortality. This project aims to identify causes of this anorexia of ageing, with a view to developing prevention and treatment strategies. We hypothesise that (1) Satiety signals are overactive in the elderly. We will determine whether older people are more sensitive to gastric distension, which reduces appetite and food intake, by measuring perceptions (fullness, hunger, etc), gastric compliance and food intake during intragastric balloon inflation. This will also be done during nutrient infusion into the small intestine, to assess the interaction between gastric and intestinal satiety factors. The contribution of age-related slowing of gastric emptying to the anorexia of ageing will be assessed and the possibility that reduced energy intake worsens the anorexia of ageing will be examined in a nutrient supplementation study. We will have shown that the release of the satiety hormone cholecystokinin (CCK) is greater in older than young adults and that CCK administration causes a greater suppression of food intake in older people, suggesting that increased CCK activity may be a cause of the anorexia of ageing. We will pursue these findings by attempting to increase appetite and food intake in the lderly by administration of a CCK antagonist (blocker). We will also measure the satiating effects of two other probable satiety hormones, amylin and glucagon like peptide 1 in older and young people. (2) The feeding drive is reduced in the elderly Opioids stimulate feeding. In animals this effect is reduced by ageing. To determine whetther this is also so in humans, the suppressive effect of the opioid antagonist naloxone on feeding will be assessed in young and older subjects.Read moreRead less
The Anorexia Of Ageing: Gastrointestinal Control Of Appetite And Feeding In The Elderly
Funder
National Health and Medical Research Council
Funding Amount
$190,500.00
Summary
On current projections, the proportion of the Australian population over 65 years will double to 25% in the next 25 years. Ageing is associated with a reduction in appetite and food intake, which has been called the anorexia of ageing. After about age 70, on average, this is associated with loss of body weight, mainly of muscle. The physiological anorexia and weight loss of ageing predispose to pathological weight loss and malnutrition, which is associated with increased morbidity and death rate ....On current projections, the proportion of the Australian population over 65 years will double to 25% in the next 25 years. Ageing is associated with a reduction in appetite and food intake, which has been called the anorexia of ageing. After about age 70, on average, this is associated with loss of body weight, mainly of muscle. The physiological anorexia and weight loss of ageing predispose to pathological weight loss and malnutrition, which is associated with increased morbidity and death rates. High rates of under-malnutrition have been reported among older institutionalised people in the USA and Australia, with lesser, but still substantial, numbers of community-dwelling older people also undernourished. We found recently that 43% of 250 older recipients of domiciliary care services living in their homes in Adelaide were either malnourished or at risk of malnutrition, and had significantly worse outcomes than their well-nourished counterparts over the following year, including increased falls and hospitalisations. Little research has been done to identify underlying causes and develop treatments for this problem. Recent studies, including ours, have shown that upper gastrointestinal (GI) factors (stomach mechanics, rate of gastric emptying, GI hormones including ghrelin, cholecystokinin [CCK] and amylin) have important effects on appetite and food intake, and are often affected by ageing in ways that reduce food intake The proposed studies will investigate this upper GI control of appetite and its contribution to the anorexia of ageing. We will investigate the effects of ageing on gastric factors, including ghrelin release, the satiating effects of CCK and amylin, and the appetite stimulating effects of ghrelin. The expected outcome of this project is a greater understanding of the causes of the anorexia of ageing, enabling the logical development of effective prevention and treatment strategies.Read moreRead less
Motivation For Starvation: Understanding The Neurobiology Of Anorexia Nervosa
Funder
National Health and Medical Research Council
Funding Amount
$773,142.00
Summary
Anorexia nervosa is a debilitating psychiatric disorder which is currently untreatable. It is characterised by disrupted reward and cognitive processing. This project, which will ultimately inform treatment strategies, utilises the activity-based anorexia rat model combined with innovative behavioural paradigms and sophisticated techniques to manipulate and record from neural circuits. This will furnish a comprehensive understanding of the neurobiology involved in pathological weight loss.
Olanzapine For Young PEople With ANorexia Nervosa: An Open-label Feasibility Study To Test Recruitment, Treatment Acceptance, Adherence, Safety, Outcome Measures And Patients' Experience To Prepare For A Randomised Placebo-controlled Trial (OPEN)
Funder
National Health and Medical Research Council
Funding Amount
$190,799.00
Summary
Olanzapine seems to be a helpful and safe medication in anorexia nervosa (AN), but it is not approved for AN. We will perform a preliminary study with 70 patients with AN (15 in Australia and 50 in the UK, age: 12-24 years) who can safely take olanzapine and have not gained sufficient weight or experienced improvement in their AN symptoms under specialist care. We will the acceptability and feasibility of olanzapine in AN. Patients will be examined after 8 and 16 weeks, 6 months and 12 months.
NPY Coordination Of Energy Balance And Physical Activity
Funder
National Health and Medical Research Council
Funding Amount
$844,596.00
Summary
Anorexia nervosa (AN) is an eating disorder characterized by behavioral alterations, restrictive eating leading to extremely low body weight. AN is also associated with a paradoxical hyperactivity representing a failure of the brain to adjust activity to energy status. Here we aim to investigate the role of the Neuropeptide Y (NPY), a known regulator of homeostatic control and activity in the development of hyperactivity in AN, thus help to identify NPY-targeted therapeutics for AN treatment.