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BackgroundPrevious studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. ObjectiveThe aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. MethodsA systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. ResultsForty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. ConclusionsTBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.

In addition to the annual summative evaluation of the entire curriculum at the Medical Faculty of Freiburg a formative course evaluation has been developed. The primary goal was a valid and detailed analysis of the quality of structure, process and outcome concerning the several courses as a basis for quality improvement.Method: The multidimensional questionnaire was constructed in consideration of academic and pragmatic aspects.The student evaluation takes place at the end of the individual course. The instructor receives the results on the next working day.Results: The internal consistency of the questionnaire as well as of its four main components supply evidence for the reliability of the procedure. Validity of content is ensured by the method of construction. The analysis of the four main components of the questionnaire shows construct validity. The assumed bias variables "interest in the subject" and "previous knowledge" did not influence the overall score. The clear improvements of the results indicate the relevance of the evaluation system.Conclusions: The formative teaching evaluation of the Medical Faculty of Freiburg allows a valid assessment of teaching quality. At the same time it provides precise perspectives for quality improving measures. Therefore it is highly accepted and effectively used by the instructors.

A comprehensive evaluation-based system for quality assurance was developed at the Medical Faculty of Freiburg during the course of several years. The system comprises the following levels:Level-I: Annual summative evaluation of the entire curriculum (academic years 1 through 5 and separately the Practical Year). The primary goal is a deficit analysis of the teaching quality of the several disciplines, thereby mainly referring to structural parameters.Level-II: Formative evaluation of the several courses/lectures with emphasis on didactic parameters. It allows a more detailed analysis of the quality of teaching. Especially those disciplines are examined that are identified by the level-I-evaluation as being in need of improvement. The intention of any form of evaluation is its use as an instrument for optimising the teaching quality. Therefore transferring the evaluation results in measures improving quality is resolutely pursued on all levels of evaluation.

Evidence accumulates that, with close medical monitoring and phosphate supplementation, higher-caloric re-alimentation protocols beginning at 2000 kcal/day (HCR) are not associated with an increased incidence of electrolyte abnormalities in patients with anorexia nervosa (AN) but rather result in faster weight gain. These studies are still scant and have largely been performed in adults or moderately malnourished adolescents. Methods: A retrospective chart review of patients with AN aged 12−20 years and with a body mass index (BMI) < 15 kg/m2 alimented according to a standardized treatment protocol in a German clinic specialized in AN was conducted. All patients received 2000 kcal/day from day one. The effect of HCR was examined with respect to laboratory changes and weight development over 4 weeks. Results: In 120 youth (119 (99.2%) females and 1 (0.8%) male, the mean BMI was 13.1 ± 1.1 (range = 10.2−15.0), %mBMI was 62.1 ± 6.0% and weight gain was 0.76 ± 0.22 kg per week, with the highest rate of weight gain during week 1 (1.25 ± 1.28 kg/week). Over 4 weeks, the total weight gain was 3.00 ± 1.92 kg. Nine patients (7.5%) developed mild hypophosphatemia, and none developed refeeding syndrome. Conclusions: Starting re-alimentation with 2000 kcal/d under close medical surveillance, severely malnourished youth with AN met the recommended weight gain targets between 0.5 and 1 kg/week according to current treatment guidelines, without anyone developing refeeding syndrome.

The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Anorexia nervosa (AN) is characterized by underweight, and the primary goal of treatment is weight restoration. Treatment approaches (ie, hospitalization for weight recovery vs for medical stabilization) and settings (ie, medical/pediatric or psychiatric units) for patients with AN vary between and also within countries. Several specialized eating disorder units worldwide have established high-caloric refeeding (HCR) protocols for patients with AN. In observational studies, HCR shortens hospital stays and increases initial weight gain, the latter being associated with a favorable long-term prognosis. However, clinicians may still remain reluctant to accept this approach for fear of medical complications of HCR, including the risk of refeeding syndrome (RS).1 Research is building toward the development of evidence-based recommendations for safe and effective re-nutrition of underweight patients with AN. This focused review was based on clinical experience and describes 3 different protocols for nutritional management devised by experts from 3 different parts of the world (Australia, Germany, and the United States), in medical refeeding of patients with AN who have established HCR in their clinical units. In addition, and in order to understand energy requirements, empirical data on energy turnover of patients with AN from former metabolic studies are presented. To the best of our knowledge, there is no study reporting on HCR in a cohort of severely malnourished adolescents with AN (ie, with a mean body mass index [BMI] of

Introduction: Although depressive disorders are frequently associated with relapses, the sustained efficacy of therapies after their termination has been insufficiently investigated. Objective: The aim of this study was to evaluate the current evidence of enduring effects of psychotherapy, antidepressants and their combination after the end of treatment. Methods: PubMed and PsychINFO were systematically screened according to PRISMA guidelines (except for preregistration). Only randomized controlled trials (RCTs) between 1980 and 2022 comparing the efficacy of psychotherapy, antidepressants and their combination in adult depression at follow-up at least 12 months after termination of therapy, which could be acute phase, maintenance or relapse prevention therapy, were included. Risk of bias was assessed by using the Cochrane risk of bias tool. Results: In total 19 RCTs with a total of 1154 participants were included. Psychotherapy was significantly superior to pharmacotherapy regarding relapse rates and Beck Depression Inventory scores at follow-up after acute treatment in two of nine RCTs. Combined treatment performed significantly better than pharmacotherapy, but not psychotherapy, regarding relapse and remission in five out of nine RCTs at least 12 months after treatment termination. Pairwise meta-analyses indicated a superiority of combined treatment compared to pharmacotherapy alone regarding relapse, recurrence, and rehospitalization rates (RR=0.60, 95%-CI: 0.37-0.97, p=.041) and for psychotherapy compared to pharmacotherapy alone regarding relapse and recurrence rates (RR=0.58, 95%-CI: 0.38-0.89, p=.023), however comparative treatment effects between psychotherapy and combined treatment were insignificant. Conclusions: Current findings suggest a superiority of psychotherapy and combined treatment over pharmacotherapy alone in major depressive disorder depression. Major limitations were a low number of studies reporting follow-up data after termination of study periods and a heterogeneity in definitions of treatment outcomes. Practice guidelines and participatory decision-making processes for the choice of treatment should consider the current knowledge on long-term effects of antidepressant therapy methods more than has been the case to date. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the longer‐term outcome of anorexia nervosa (AN) in female adolescent inpatients (N = 132). Method: A follow‐up (mean 8.2 years) after treatment was conducted. A subsample of 39 patients with at least 10 years of follow‐up (mean 14 years) was defined. Results: Over the 8‐year follow‐up period, the body mass index (BMI) increased from 14.33 (1.65) to 19.04 kg/m2 (2.97; t[112] = 17.33, p < 0.001, d = 1.63), and BMI percentiles increased from 0.50 (1.14) to 24.96 (26.81; t[112] = 9.83, p < 0.001, d = 0.92). Remission was found in 32.5% (8‐year total sample) and 48.6% (14‐year subsample). In the 8‐year total sample, 15.1% still had AN or had relapsed (8.1% in the 14‐year subsample). A cross‐over from AN to binge‐eating disorder was rare. The main cross‐over occurred from AN to an eating disorder not otherwise specified (37.5% and 27.0%, respectively). The standardized mortality ratio was 21.7. Discussion: In the long run, eating disorder diagnoses decreased significantly. Although a considerable proportion of patients recovered from their eating disorder, the number of recovered patients remained limited, with long‐term negative consequences in a large proportion of patients. Standardized mortality was excessive, calling for ever‐better therapies. Additional studies are needed to show if improved therapies lead to a better long‐term outcome. [ABSTRACT FROM AUTHOR]