Abstract Body

The framing of care pathways involved in management of anorexia nervosa have undergone many changes over time. In the 19^th century it was mainly physicians who managed these cases and produced behavioural change through a change in setting. Later social and psychological formulations were introduced. The most recent paradigm shift has been driven by genetic studies which have shown correlations with metabolic as well as psychiatric and psychological disorders. These findings align with longitudinal studies which show lifetime patterns of leanness and depression and anxiety. This complex mix of somatic and neurobiological risk at a critical time of development can lead to a lethal, or enduring illness. The cognitive interpersonal model (Schmidt & Treasure, 2006) emphasises valued and visible maintaining factors which interact with the neurobiological underpinnings (Treasure & Schmidt, 2013; Treasure et al 2020).

Targets for treatment can be derived from the model. For example, we have defined the consequences on close others (including health professionals) of living with the illness and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. Also, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression and neuroadaptation. Thus, anorexia nervosa develops a life of its own, resistant to treatment. In this talk I will describe some of the neurobiological foundations and how these interacts with social systems and how these can be remediated by treatment.

Abstract Body

Background. Inpatient care for anorexia nervosa is used for patients at high medical and psychiatric risk and who cannot be safely managed as outpatients. Approximately a third of patients relapse within the first 6 months. The aim of this programme of work was to examine whether psychoeducational interventions preparing for the transition back to the community codesigned by, and for, carers and patients to carers are of benefit.

Methods

Study 1 (CASIS). Patients (n=178) admitted to inpatient units across the UK entered a randomised trial in which carers received treatment as usual, with, or without augmentation with carers self-management materials. Outcomes were followed over two years (Hibbs et al 2016, Magill et al 2017).

Study 2 (TRIANGLE pilot) Patient (n=31) and carers (n=21) admitted to inpatient care were given the ECHOMANTRA intervention (with separate subsections for each) and were followed for 3 months after discharge (Adamson et al 2019).

Results

In CASIS, carer burden was reduced (Effect size 0.5) as was carer emotional behaviour (Effect size 0.5). The length of admission was shortened (148 vs 168 days) and re-admission rates were reduced (27% vs 32%; p=0.04). In the TRIANGLE pilot there were positive comments about the collaborative work from both parties. The length of admission was reduced by 4.5 weeks and weight gain was increased by 0.11 kg/week in the group given the ECHOMANTRA intervention in comparison to outcomes from audit data.

Conclusion

Augmenting treatment to help patients and carers to prepare for discharge can consolidate changes from inpatient care.