Newbridge master class series

The latest Master Class event with Professor Stephen Touyz produced lively, wide ranging debate throughout a very well received programme.

Professor Touyz, who has written six books and published more than 300 papers, provided a comprehensive overview of key new research and invited participants to debate and appraise approaches to the treatment of patients with anorexia nervosa.

The Master Class, which took place at New Hall Hotel, Sutton Coldfield on March 20, included the results of a randomised controlled trial comparing inpatient treatment of anorexia nervosa with a family therapy based outpatient approach.

Prof Touyz, who is Professor of Clinical Psychology at the University of Sydney, Australia, asked participants to consider: “Once we have medically stabilised a patient in hospital, what are the reasons why we are keeping the patient in hospital after that?”

There was a wide-ranging discussion about whether it would be feasible and safe for all patients to remain at home for family based treatment.

There was also debate about how recovery is measured following treatment for anorexia nervosa and whether the criteria used in some studies is too rigid to take into account progress made.

“Every patient takes their own journey to recovery and people will get to different stages of that journey,” said Professor Touyz. “Some people will go on to lead productive lives, stay out of hospital and raise a family, but will still have some symptoms and difficulties.

“What we all agree on is that if there is a short time frame between the onset of the anorexia and effective treatment, the individual is more likely to make a fuller recovery. We must not miss this early opportunity.”

Professor Touyz presented data from functional Magnetic Resonance Imaging (fMRI) showing how brain activity is affected by anorexia nervosa. There was also an overview of neurological studies assessing how people with anorexia nervosa performed on cognitive tests.

The studies showed people with anorexia nervosa were strong on detail, but poor on central cohesion (ability to see the bigger picture) and set shifting (flexibility to quickly shift attention from one task to another).

Professor Touyz explained it is not certain whether people have these deficits before anorexia nervosa develops or whether the deficits are caused by their illness. The data also shows it is possible to recover from anorexia nervosa while still having these deficits.

There was a session on the role of exercise in the treatment of anorexia nervosa “It is a symptom of anorexia nervosa which many units avoid because they don’t know what to do about it,” said Professor Touyz. Studies show exercise often precedes an eating disorder and is frequently the last symptom to subside.

There was a wide-ranging discussion about how eating disorders units should manage exercise within the treatment programme. While there was agreement that carefully monitored, appropriate exercise should be offered, this must not work against weight gain.

Participants discussed patients they had worked with undertaking high risk sports and how best to support their activities but ensure they make a safe and full recovery.

The afternoon session began with a session on re-feeding. Now that units have confidence in their ability to manage the risk of re-feeding, Professor Touyz explained that in some services, the programme is designed for very rapid weight gain.

Professor Touyz introduced a study he carried out exploring the psychological consequences of rapid re-feeding. There was consideration of the relative benefits of a short term hospital stay with quick weight gain, compared with potential long term psychological harm from that approach.

The day concluded with a session on the role of the family meal in the inpatient treatment of anorexia.

Professor Hubert Lacey, Medical Director of Newbridge House, who established the Master Class programme, commented: “The day with Professor Touyz was an overwhelming success.

“It was a particularly lively event, generating great debate and reflection and was highly relevant to the challenges we all face in our clinical work. We are very grateful to Professor Touyz for his skill as a facilitator of debate and also for the breadth of research data and developments he presented in very comprehensive programme.”

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