Eating disorders professionals from throughout the UK gathered for the seventh Newbridge House Masterclass with Dr Sloane Madden.
Dr Madden, who leads the largest public eating disorders service in Australia, delivered a highly comprehensive and engaging day of training on March 14th.
Sessions encompassed: the role of hospitalisation in the treatment of anorexia nervosa – what does the literature tell us? Managing medical risk and optimising refeeding outcomes in adolescent inpatients with anorexia nervosa, together with a third session on the predictors of remission and what to do when there is a poor treatment response.
Dr Hubert Lacey, medical director of Newbridge House, who originated the Masterclass series, told the audience: “I would like to congratulate Dr Madden on really innovative thinking in the way you have developed services. I particularly like the way that today, you have sometimes said: ‘We don’t know.’ I think this is the hallmark of the great clinician; you work out what you want to do and then you continually test and measure it.”
Each session considered what the research literature tells us about the theme in question and what this means for clinical practice.
For the past 15 years, Dr Madden has been the director of the eating disorder service at The Children’s Hospital, Westmead, Sydney and is now also coordinator of the largest public eating disorder service in the country.
Dr Madden presented data the random controlled trial (RCT) led by his service, comparing outcomes for brief hospital admissions for medical stabilisation to longer admissions (six to eight weeks) in medically compromised adolescents with anorexia nervosa treated both followed by outpatient Family Based Treatment.
He described the results which showed longer initial hospitalisation aimed at weight restoration did not reduce the need for further hospitalisation or improve treatment outcomes. In his own service, average length of hospital stay is 22 days (for patients with first episode of anorexia). Discussions followed reflecting on how short hospital stay is dependent upon strong, evidence based outpatient services.
In the session on optimising refeeding, Dr Madden said studies, including those from his own unit, showed higher weight gain in the first four weeks of family based treatment is associated with higher rates of remission. There was discussion about the lack of consensus in this area and the dangers of under feeding, together with detailed consideration of what is required for nutritional restoration for severely malnourished children and adolescents.
The afternoon session considered remission and recovery. “We know early treatment leads to better outcomes,” said Dr Madden. “What we don’t know is who are the 50 per cent who are most likely to respond to treatment.”
What is known, he explained, is predictors of potentially poorer treatment response. These include high degree of parental criticism, severe obsessive compulsive disorder, emotional dysregulation and rigidity/perfectionism (but with all predictors, with a longer treatment period, a good response can be achieved).
Dr Madden described a novel approach used in the service he leads, in which the whole family is admitted to hospital for intensive eating disorder treatment. The treatment is for a minimum of two weeks allowing for a higher intensity dose of family based treatment.
This was an over-subscribed and extremely well received Masterclass. The next Masterclass will be led by Dr Ulf Wallin, a specialist in family therapy based at the University of Lund, Sweden. This Masterclass will take place in June 2016, at a date to be announced. To register your request to attend, please email: Mandy.Deakin@newbridge-health.org.uk
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