Abstract
BackgroundAnorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life. AN is one of the leading causes of disease burden in terms of years of life lost through death or disability in young women. Psychotherapeutic interventions are the treatment of choice for AN, but the results of psychotherapy depend critically on the stage of the illness. The treatment response in adults with a chronic form of the illness is poor and drop-out from treatment is high. Despite the seriousness of the disorder the evidence-base for psychological treatment of adults with AN is extremely limited and there is no leading treatment. There is therefore an urgent need to develop more effective treatments for adults with AN. The aim of the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC) is to evaluate the efficacy and cost effectiveness of two outpatient treatments for adults with AN, Specialist Supportive Clinical Management (SSCM) and the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA).Methods/Design138 patients meeting the inclusion criteria are randomly assigned to one of the two treatment groups (MANTRA or SSCM). All participants receive 20 once-weekly individual therapy sessions (with 10 extra weekly sessions for those who are severely ill) and four follow-up sessions with monthly spacing thereafter. There is also optional access to a dietician and extra sessions involving a family member or a close other. Body weight, eating disorder- related symptoms, neurocognitive and psychosocial measures, and service use data are measured during the course of treatment and across a one year follow up period. The primary outcome measure is body mass index (BMI) taken at twelve months after randomization.DiscussionThis multi-center study provides a large sample size, broad inclusion criteria and a follow-up period. However, the study has to contend with difficulties directly related to running a large multi-center randomized controlled trial and the psychopathology of AN. These issues are discussed.Trial RegistrationCurrent Controlled Trials ISRCTN67720902 - A Maudsley outpatient study of treatments for anorexia nervosa and related conditions.
Highlights
Anorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life
One of the key factors responsible for the relative lack of efficacy of treatments for adults with AN is that most of these have been adapted from those for other disorders and are neither tailored sufficiently to the characteristics and needs of people with AN nor focused on how the disorder is maintained. To remedy this problem we have developed a specific maintenance model and treatment approach for AN [5], the Maudsley Model of Treatment for Adults with AN (MANTRA)
(MANTRA) will be superior to Specialist Supportive Clinical Management (SSCM) in producing greater weight gain and greater improvement in eating-disorder related psychopathology in adults with AN at six and twelve months. (2)MANTRA will be more cost-effective than SSCM, showing lower costs at six and twelve months. It will be associated with fewer and shorter hospitalizations during treatment and follow-up compared to SSCM
Summary
Anorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality and disability, physical and psychological morbidity and impaired quality of life. AN is one of the leading causes of disease burden in terms of years of life lost through death or disability in young women. AN is one of the leading causes of disease burden in terms of years of life lost through death or disability in young women [6], and the cost per case of AN is at least equal to that of schizophrenia [7,8]. It estimated a total cost for England, per year of 1.25 billion GBP This figure includes costs to the NHS and private healthcare, the human costs and the cost of lost output. The report estimated the cost to healthcare being over 80 million GBP. Most of this can be attributed to the cost of AN
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