beauty ideal AED CONFERENCE 2017 1989 1983 Body shape Sexuality - - PowerPoint PPT Presentation

EATING DISORDERS SERVICES (REALITY) AND

EVIDENCE-BASED TREATMENT GUIDELINES

Hana Papežov{

Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague

Kaunas

EEEDN 2018 Kaunas

History – beauty ideal

the Paleolithic period (35,000 B.C.E). 1989 1983 Body shape Sexuality Fertility AED CONFERENCE 2017

Charles University Prague, CR

• Founded in 1348 as one of the oldest universities

in Europe.

• Contains 17 faculties, 3 collegiate

institutes, 6 additional establishments for educational, scientific, research

• The Faculty of Medicine has been part of

Charles University in Prague since 1348 and is the oldest faculty of Medicine in Central Europe.

Psychiatric Department 1st Medical School

• The oldest psychiatric clinic in our country,

Arnold Pick, described the brain degenerative disorder “Morbus Pick” Jan Janský, discovered of the fourth blood group AB Kurt Freund, author of phalopletysmographic examination

Eating Disorder Center

• Frantisek Faltus established Eating Disorders Unit in 1982-3

as the first one in the Central and Eastern Europe.

• Hospitalization program 1-12 beds 1982-3
• Developed following European and Czech evidence-based

standards.

• Day care center 2002-3
• Collaboration with Child and Adolescent Day Care Center
• Outpatient clinic, consultation and short motivational

psychoeducation interventions, MFT

• Collaboration with Self help organisation 1992

Epidemiology and planning ED services

Hospitalisations for ED in the Czech Republic / 100 000 (1981-2005)

Pavlova et al. 2007

Hospitalisations 2008-2015

100 200 300 400 500 600 2008 2009 2010 2011 2012 2013 2014 2015

Vývoj počtu hospitalizací pro poruchy příjmu potravy (PPP)

ment{lní anorexie ment{lní bulimie

• statní PPP

Out-patients services in the CR

2011-2015

Incidence of F.50 diagnoses 123 new cases /100 000 inhabitants

Psychiatric hospitalisation and age distribution

2006 - 2011

*GB: Proportion of AN cases fulfilling MKN-10 criteria for admission: 70% of adolescents; 50% of adults

Eating Disorder Service

Czech Republic

10 millions inhabitants

• in 2011: 339 hospitalisations in 272 pts
• Proportion of new referrals by diagnosis

AN* BN BED 63% atypical 7% 20% 0,1-9%

Hospitalisations and refusals from the wating list (WL)

1998-2008

Inpatient Service

• Psychiatric Ward; 12 beds for ED,
• 12 for somatoform and rehabilitation
• Treatment 24-hours per day, 7 days per week.
• Age 18 upwards; exc. from 16
• Severe AN, BN, BED acute or chronic; local or

national

• Patients are realimented back to a healthy weight
• Supportive structured group milieu
• Regular medical reviews
• Group therapy: motivational enhancement therapy;

CBT, cognitive remediation

• Links to Child and Adolescent Univerzity hospital

Motol and Day Care Center for Child and Adolescent Unit at our Clinic.

Day-care for Adults

(8-12 places)

• Age 17 upwards
• Patients with moderately severe AN (BMI

16),BN, BED

• 8-hours per day, 5 days per week
• Regular meals in a friendly, non-institutional

setting, and Multiple group activities .

• Comprehensive program: CBT regime and

dynamic approaches, relapse prevention and post hospitalization program.

• Clubs for patients ,family members, MFT.

DHP Toronto TCE Munich OLOL Los Angeles DSPPPP Prague

Foundation

1986 1990 1991 2002

Program

4 days 10-18,15 h 7 days 8-17 h 5 days 9,30-17,30 h 5 days 8,00-16,30 h

Connected to In- and out- patients services

yes yes yes yes

• Max. No
• f patients

12 24 13 12

Meals

Lunch, diner, snack Breakfast, lunch, diner, snack 2x Lunch, diner Breakfast, Lunch, diner, snack 2x

Day Care Centers

(Chudobov{, Papežov{, 2003)

Day Care Centers - program

(Chudobov{, Papežov{, 2003)

DHP Toronto TCE Mnichov OLOL Los Angeles DSPPPP Praha

CBT l l l l Dynamic PT l l l Art therapy l l Body work l l l l Manuals (meal plans

• spec. nurse)

l l l l FT l Psychoeducat ion l l l Relaxation l l

Outpatient Services for Adults

Out-patient care (short interventions):

• Different time-limited individual diagnostic, educational

and psychotherapeutic interventions

• Consultations and supervisions
• MFT
• CBT
• Self-help/guided groups 1/month
• Clubs and On line services for patients, carers, schools

Therapeutical quidelines

INTERNATIONAL RESEARCH

• COST ACTION B6 1995-2001
• INTACT 2005-2011 (Genetic Study GCAN)

COST B6 ACTION (ED multicentric study on treatment efficacy - 1993-2001)

country % positive outcome AN % positive outcome BN CZ 31,5 32,2 D 20,6 32,2 F 25,7

• GB

17,7 23,3 NL 49,5 56,2 PL 16,6 23,5 Spain 29,9 40,4

Pro-youth.eu Specialized ED team Primary care doctors, Specialists, Pediatrists Nutrition therapists

Limitations and new treatments

SEAN & comorbidity

• CHRONIC SEVERE EATING DISORDERS: >50% of

patients with AN need long-term multi-disciplinary care and long-term involvement from specialist services

• DUAL DIAGNOSIS: Many cases of AN& BN have

significant co-morbid disorder (OCD, anxiety disorders, PTSD, alcohol & substance misuse, personality disorder)

Comorbidities personality disorders and abusers

• H. Lacey, St. George Hospital, London

(Multi-impulsive forms of ED) Important preparation and quality of evaluation of the patient

• Stable and structured care
• Multidisciplinary collaboration
• Culture of the ward

Hohenneg, Switzerland 2003

Treatment cost

• 1,9 milion men and 2 milion women žen
• Hospitalized 21,5% AN, less BN a EDNOS
• AN $6045,
• BN $2962,
• EDNOS $3207,
• Schizophrenia $4824,
• OCD $1930

Striegel-Moore RH et al., 2000

In EUROPE 680 million Euro/year

„Adequate therapy“

Crow & Nyman 2004

• As usual

$36 200

• Adequate $119 200
• 1 year survival $30 180

Calculation /mortality, age, treatment response and mean duration of life/

• Drake RE et al., Implementing evidence-based practices in routine mental health service
• settings. Psychiatr Serv, 52, 2001,179-82.

ED cost in the CR

Limitations

• f implementation
• EDU - under-resourced – more and more new strategies

are political decision.

• Pessimism regarding changes in ED behaviour

Agras and al., Int J Eat Disord, NIH, 2004

• List of new developments not comprehensive (e.g. what

about BED)

• Implementation of research to clinical practice.

Decrease of young medical doctors interest in the

• topic. Vandereycken 2011
• Manualized programs and quidelines are not realised as

expected, refusal to change

Faiburn 2004, AED konference

New technologies and social network

Technology-enhanced interventions for step-up and step-down care

Prevention and early intervention

• CD-ROM for BN, BED
• CD-ROM for body image work
• CD-ROM for carers
• Web-based relapse prevention and support

Debra Franco Praha 2003 PREVENCE ŠKOLY A SPECIALIZOVAN[ ZAŘÍZENÍ Zaměření na rizikovou populaci

WWW.PROYOUTH.EU

Online pro-Youth: Promotion of young people‘s mental health through technology-enhanced personalization of care

The PRO-YOUTH network

Germany: Center for Psychotherapy Research Czech Republic: Charles University, Prague Romania: University of Babes-Bolyai, Cluj-Napoca Italy: Studi Cognitivi, Milan Ireland: Trinity College, Dublin Hungary: Semmelweis University, Budapest Netherlands: Stichting Rivierduinen, Leiden

PRO YOUTH Projekt 2011- 2014

The PRO-YOUTH platform

Updated software, based on Es[s]prit and YoungEssprit (Bauer et al., 2009; Lindenberg et al., in press)

Consultation Chat F2F Counseling Monitoring Screening Psychoeducation & Peer Support

New: Involvement of young people in development and delivery

PRO YOUTH Projekt 2011-2014

Comics by peers

„I was just a normal young girl“.

(Aneb co se může stát, když se zvrtne jídlo). Autorka kreseb i textu:

• A. Tejklová

Healthy and free

• PC game application focused on

the prevention of the eating disorder.

• The primary objective of this

application is to address the teenage girls in the age of 13- 16, to offer them the information about eating disorder in the form

• f a PC game as well as the

contact details for professional help.

• The interactive photo comics with

music and spoken commentary.

• The main character of this comics

suffers from eating disorder and her classmates try to find out, why she is absent from school.

• Step by step, they learn what are

the symptoms and the consequences of this serious disease, what is the risky behaviour related to it and how they could help their friend.

• From the perspective of the

player, it is a detective story; at the very start the player doesn’t know that it is related to the theme of eating disorder.

• Logical riddles and mini

games, orientation tests for the players.

• The player has the possibility to

influence the storyline, the story moves forward depending on the player`s decisions.

• Informal elements, colloquial

language of the teenagers.

• Distribution: online free of charge

www.divcivalka.net

Website: www.pomocppp.cz

• Simple website, no

compulsory screening

• r monitoring

questionnaires

• Regular chats – after

registration

• Forum – no registration
• 741 unique page

visitors during one year (02/2012-02/2013)

(65 % new visitors, 35 % returning)

• 25 registered so far

It is the most read article

• n the website – 16 018 times

read.

Advances in Eating Disorders Theory, Research, Practice, 2013

• Hegemony of hard-core research, the current reign
• f evidence-based practice, demand for rigid

adherence to manuals or to a particular form of therapy…

• None of our current therapies have better than a 70%

full and sustained recovery – we have a long way to go.

• Open-minded clinical observation and

experience, unhampered and creative thought, hypothesis development, conceptual considerations,

Vigorous debate and listening to our patients are just as valuable sources.

Rachel Bryant-Waugh and Bryan Lask, 2013

Long term goals Reforme of Psychiatry

• Ensure patients get early access to specialist care ( Failure

to early leads to chronicity)

• Alleviate pressure on EDU and reduce WL
• More targeted use of resources
• Transfer intervention to primary care – education –

improve interdisciplinary cooperation

• New strategy in psychiatry – Czech Reform toward

Community system for Severe Mental Illnesses.

• U. Schmidt : Service vision 2001

• XII. International and Interdisciplinary

Conference on Eating Disorders and 0besity

April 2019

Psychiatric Department VFN a 1.LF UK Ke Karlovu 11 12821 Praha 2-12821 Nové město

Thanks for your attention

Goals of the EDU

To provide an excellent, comprehensive specialist clinical service:

• patient and carer-centred
• well integrated with primary & secondary care

To take a lead in developing, evaluating & disseminating new treatments and services and pre and post-gradual education