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Carlos M Grilo - One of the best experts on this subject based on the ideXlab platform.
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randomized controlled trial testing behavioral weight loss versus multi modal stepped care treatment for binge eating disorder
European Psychiatry, 2016Co-Authors: Carlos M GriloAbstract:Introduction Binge eating disorder (BED) is prevalent, associated with obesity and elevated Psychiatric Co-Morbidity, and represents a treatment challenge. Objective and aims A controlled comparison of multi-modal, stepped-care versus behavioral-weight-loss (BWL) for BED. Methods One hundred and ninety-one patients (71% female, 79% white) with BED and co-morbid obesity (mean BMI 39) were randomly assigned to 6 months of BWL (n = 39) or stepped-care (n = 152). Within stepped-care, patients started BWL for one month; treatment-responders continued BWL while non-responders switched to cognitive-behavioral-therapy (CBT) and all stepped-care patients were additionally randomized to anti-obesity medication or placebo (double-blind) for five months. Independent assessments were performed by research-clinicians at baseline, throughout treatment, and post-treatment (90% assessed) with reliably-administered structured interviews. Results Intent-to-treat analyses of remission rates (0 binges/month) revealed BWL and stepped-care did not differ significantly overall (74% vs 64%); within stepped-care, remission rates differed (range 40% - 79%) with medication significantly superior to placebo (P Conclusions Overall, BWL and stepped-care treatments produced improvements in binge-eating and weight loss in obese BED patients. Anti-obesity medication enhanced outcomes within a stepped-care model.
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predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder
Journal of Consulting and Clinical Psychology, 2012Co-Authors: Carlos M Grilo, Robin M Masheb, Ross D CrosbyAbstract:Binge-eating disorder (BED), a research category in the DSM-IV (American Psychiatric Association, 1994), is characterized by recurrent binge-eating accompanied by feelings of loss of control and marked distress in the absence of inappropriate weight compensatory behaviors. BED is prevalent (Hudson, Hiripi, Pope, & Kessler, 2007) and strongly associated with obesity, elevated Psychiatric and medical Co-Morbidity, and psychosocial impairment (Grilo, White, & Masheb, 2009; Hudson et al., 2007). BED differs from obesity and other eating disorders on numerous clinical markers (Allison, Grilo, Masheb, & Stunkard, 2005; Grilo et al., 2008; Grilo, Masheb, & White, 2010). Although some effective medication (Reas & Grilo, 2008) and psychological (Wilson, Grilo, & Vitousek, 2007) treatments have been identified for BED, even in studies with the best outcomes, a substantial proportion of patients do not achieve abstinence from binge-eating, and most clinical trials have reported little to no weight loss (Wilfley et al., 2002; Wilson, Wilfley, Agras, & Bryson, 2010). Thus, it is important to find ways to predict BED patients’ response to treatments as this may lead to more effective decision-making about treatment prescriptions (Kraemer, Wilson, Fairburn, & Agras, 2002). Relatively few data have been published on predictors of outcome for BED and critical reviews have highlighted the significant methodological shortcomings of most of this literature (Berkman, Lohr, & Bulik, 2007). Early studies identified several factors that may be associated with poor outcome. In some studies, severity of binge-eating (Agras et al., 1995; Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Loeb, Wilson, Gilbert, & Labouvie, 2000; Peterson et al., 2000), earlier onset of BED (Agras et al., 1995), and younger age at time of presentation for treatment (Agras et al., 1997) predicted worse binge-eating outcomes, whereas Psychiatric Co-Morbidity was generally unrelated to treatment outcomes (Wilfley et al., 2000). Recent studies, which performed more sophisticated and systematic analyses, have identified some additional potential patient predictors of treatment outcome for BED although they have generally failed to replicate many of the potential predictors identified in the first-generation studies. Hilbert and colleagues (2007) reported that greater interpersonal problems and greater shape/weight concerns predicted poorer treatment outcomes. Masheb and Grilo (2008a) reported that binge-eating frequency, eating-disorder psychopathology, and depressive levels significantly predicted their respective post-treatment levels and that personality disorders predicted higher levels of eating-disorder psychopathology and depressive levels at post-treatment. Wilson et al (2010) reported that education, depression levels, and self-esteem predicted binge-eating remission. Thus, relatively little is known about predictors of treatment outcome for BED and overall the best conclusion is that reliable predictors have yet to be identified. Even less is known about treatment moderators for BED. We are aware of six published reports of analyses of moderators (Hilbert et al., 2007; Masheb & Grilo, 2008a, Masheb & Grilo, 2008b; Robinson & Safer, 2011; Sysko, Hildebrandt, Wilson, Wilfley, & Agras, 2010; Wilson et al., 2010). Hilbert and colleagues (2007) explored numerous clinical variables but failed to find any significant moderators for CBT and interpersonal psychotherapy (IPT) delivered via intensive group formats. Similarly, Masheb and Grilo (2008a) tested numerous variables (age, Psychiatric and personality-disorder Co-Morbidity, binge-eating, eating-disorder psychopathology, self-esteem, and depressive levels) and failed to find any significant moderator effects in a controlled trial comparing CBT and behavioral weight loss (BWL) treatments delivered via guided-self-help (i.e., CBTgsh and BWLgsh). Masheb and Grilo (2008b), in a further re-analysis of moderation effects found that two different sub-typing methods – grouping by negative-affect (Grilo, Masheb, & Wilson, 2001a; Stice & Agras, 1999; Stice & Fairburn, 2003) or by overvaluation of shape/weight (Grilo et al., 2008; Hrabosky, Masheb, White, & Grilo, 2007) – predicted worse outcomes but did not significantly moderate BED treatment outcomes. Robinson and Safer (2011) tested a broad range of demographic, Psychiatric, and clinical variables and reported that the only factors that moderated better response to dialectical behavior therapy versus an active comparison group therapy were the presence of personality-disorder pathology and earlier onset of overweight and dieting. Wilson and colleagues (2010) tested numerous clinical variables including negative-affect sub-typing and reported that two variables - self-esteem and global eating-disorder psychopathology - significantly moderated treatment outcomes; patients with lower self-esteem and higher eating-disorder psychopathology benefiting more from IPT than from BWL or CBTgsh. Lastly, Sysko and colleagues (2010), in a further analysis of moderation effects in the Wilson et al (2010) trial, found that heterogeneity significantly moderated outcomes. Specifically, latent-class-analysis identified two classes of patients characterized by greater severity of binge-eating, shape/weight concerns, and depression levels, that were significantly more likely to remit from binge-eating if receiving IPT or CBTgsh. In the present study, we examined predictors and moderators of response to individual CBT and antidepressant medication for BED. This study is important for several reasons. CBT is considered the best-established treatment for BED (NICE, 2004; Wilson et al., 2007). Findings from Masheb and Grilo (2008) and Wilson et al (2010) pertain to CBTgsh (not traditional CBT) and are mixed. Antidepressant medications are considered an acceptable alternative treatment for BED (NICE, 2004). Although some studies have questioned the clinical-effects of antidepressants for BED (Ricca et al., 2001; see: Reas & Grilo, 2008), these medications are frequently and widely prescribed. If moderators of treatment response to CBT versus antidepressant medication could be identified, this would inform rationale treatment prescription.
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cognitive behavioral therapy behavioral weight loss and sequential treatment for obese patients with binge eating disorder a randomized controlled trial
Journal of Consulting and Clinical Psychology, 2011Co-Authors: Carlos M Grilo, Robin M Masheb, Terence G Wilson, Ralitza Gueorguieva, Marney A WhiteAbstract:Binge-eating disorder (BED), a research category in the DSM-IV (American Psychiatric Association, 1994), is characterized by recurrent binge-eating accompanied by feelings of loss of control and marked distress in the absence of inappropriate weight compensatory behaviors. BED is a prevalent major health problem (Hudson, Hiripi, Pope, & Kessler, 2007). BED has diagnostic validity (Wonderlich, Gordon, Mitchell, Crosby, & Engel, 2009), differs from other eating disorders and obesity (Grilo et al., 2009; Grilo, Hrabosby, White, Allison, Stunkard, & Masheb, 2008), and is strongly associated with obesity and elevated risk for medical/Psychiatric Co-Morbidity (Hudson et al., 2007; Wonderlich et al., 2009). The treatment literature for BED suggests that several medications have short-term efficacy relative to placebo (Reas & Grilo, 2008) and certain psychological treatments are effective (Wilson, Grilo, & Vitousek 2007). Cognitive-behavioral therapy (CBT) is the best-established treatment (NICE, 2004; Wilson, Wilfley, Agras, & Bryson, 2010). The National Institute of Clinical Excellence (2004) recommendation that CBT is the treatment-of-choice was assigned a “grade-of-A,” reflecting strong empirical evidence. Controlled trials have provided further support for the efficacy of CBT, including “treatment specificity” (Grilo, Masheb, & Wilson, 2005); however, studies have reported little difference between interpersonal psychotherapy (IPT) and CBT delivered via group (Wilfley et al., 2002) or CBT guided-self-help (Wilson et al., 2010). Although CBT generally produces remission rates of 40% to 60% and robust improvements in eating disorder psychopathology it fails to produce weight loss (Wilson et al., 2007). The association between BED and obesity (Hudson et al., 2007) and the possible heightened risk for developing future metabolic problems (Hudson et al., 2010) highlight the need to find methods to effectively reduce weight - in addition to eliminating binge-eating - in persons with BED. The existing literature of behavioral-weight-loss (BWL) for BED is equivocal and difficult to interpret in light of significant methodological shortcomings, particularly the reliance on self-report questionnaires for the assessment of binge-eating, inclusion of heterogeneous patients with varying sub-threshold levels of BED, and a lack of follow-up data (see Wilson et al., 2007; Wonderlich et al., 2009). Overall, CBT appears more effective for reducing binge-eating and associated psychopathology whereas BWL appears more effective for producing short-term weight loss (e.g., Agras et al.,1994; Wilson et al., 2010) although BWL studies in BED (e.g., Devlin et al., 2005; Grilo & Masheb, 2005) and “binge-eaters” (Goodrick, Poston, Kimball, Reeves, & Foreyt, 1998) often report minimal or no weight losses. Interestingly, the modest short-term weight-loss reported by most studies testing BWL for obese BED patients (see Wilson et al., 2007) is at odds with the greater magnitude of weight-losses reported for obese patients who do not binge-eat receiving BWL recruited for obesity trials (e.g., Foster et al., 2003) and with findings from one obesity treatment study in which a post-hoc re-analysis of outcomes for “binge-eaters” (determined by self-report) revealed superior short-term weight-losses relative to non-binge-eaters (Gladis, Wadden, Vogt, Foster, Kuehnel, & Bartlett, 1998). The current study, a randomized controlled trial to test the relative efficacy of CBT and BWL for BED and the durability of the outcomes over a 12-month follow-up period, was designed as a test of treatment-specificity and to help answer the clinically important question of whether BWL has efficacy for weight loss in this subgroup of obese patients. This study also tested the utility of a sequential treatment approach in which CBT is delivered first followed by BWL. Given findings from RCTs that binge remission was associated with greater weight losses (Devlin et al., 2005; Grilo et al., 2005; Wilfley et al., 2002), the comparison to the sequential CBT+BWL treatment follows the clinical hypothesis that once CBT reduces binge eating and associated psychopathology, patients will be able achieve greater weight loss with BWL.
Giorgio Zoli - One of the best experts on this subject based on the ideXlab platform.
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients according to lesch typologies a pilot study
Journal of Psychopharmacology, 2014Co-Authors: Fabio Caputo, Giovanni Addolorato, R Brambilla, Arfedele Del Re, Giorgio Zoli, Federica Vignataglianti, Alice Grignaschi, Teo Vignoli, Mauro Cibin, Mauro BernardiAbstract:Sodium oxybate (SO) is a γ-amino-butyric acid (GABA)-ergic drug currently used for the treatment of alcohol dependence (AD) in some European countries. The aim of this study was to describe the effect of SO administration in alcoholics classified according to Lesch alcoholism typology (LAT). Forty-eight patients were enrolled and classified into four groups according to LAT. All patients were treated with oral SO (50 mg/kg of body weight t.i.d.) for 12 weeks. All patients significantly reduced their alcohol intake (p<0.001). Alcohol abstinence during the 12 weeks of treatment did not differ between the four groups at the end of treatment. Craving for SO did not significantly differ amongst groups; cases of SO abuse were very limited and were observed in almost 10% of patients. In conclusion, our study showed an overall efficacy of SO in the treatment of AD irrespective of LAT categories. However, our results confirm that alcoholics with Psychiatric Co-Morbidity, particularly with a borderline personality ...
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients with and without Psychiatric comorbidity
European Neuropsychopharmacology, 2011Co-Authors: Fabio Caputo, Giovanni Addolorato, Lorenzo Leggio, Sara Francini, R Brambilla, Michela Stoppo, Arfedele Del Re, Federica Vignataglianti, Giorgio ZoliAbstract:Sodium oxybate (SMO) is a GABA-ergic drug currently used for the treatment of alcohol-dependence in some European countries. In particular, clinical studies have shown a role of SMO in promoting alcohol abstinence, as well as in relieving withdrawal symptoms. The aim of this study was to describe alcohol abstinence and the onset of craving for and abuse of SMO in alcohol-dependent subjects with and without Psychiatric Co-Morbidity. Forty-eight patients were enrolled and classified into two groups: group A (20 alcoholics without any Psychiatric Co-Morbidity) and group B (28 alcoholics with a Psychiatric Co-Morbidity). All patients were treated with oral SMO (50 mg/kg of body weight t.i.d.) for 12 weeks. Alcohol abstinence as well as alcohol drinking during the 12 weeks of treatment did not differ between the two groups at the end of treatment (p=0.9). In addition, a reduction of alcohol intake in both groups has been observed (p<0.0001). On the other hand, craving for SMO was significantly more frequent in group B than group A (p=0.001). Cases of SMO abuse were observed in almost 10% of group B patients. In conclusion, alcohol abstinence achieved through SMO administration does not differ in patients with and without Psychiatric Co-Morbidity. However, alcoholics with co-morbid borderline disorders appear to be at high risk of developing craving for and abuse of the drug; therefore, SMO may not be indicated in these patients.
Fabio Caputo - One of the best experts on this subject based on the ideXlab platform.
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients according to lesch typologies a pilot study
Journal of Psychopharmacology, 2014Co-Authors: Fabio Caputo, Giovanni Addolorato, R Brambilla, Arfedele Del Re, Giorgio Zoli, Federica Vignataglianti, Alice Grignaschi, Teo Vignoli, Mauro Cibin, Mauro BernardiAbstract:Sodium oxybate (SO) is a γ-amino-butyric acid (GABA)-ergic drug currently used for the treatment of alcohol dependence (AD) in some European countries. The aim of this study was to describe the effect of SO administration in alcoholics classified according to Lesch alcoholism typology (LAT). Forty-eight patients were enrolled and classified into four groups according to LAT. All patients were treated with oral SO (50 mg/kg of body weight t.i.d.) for 12 weeks. All patients significantly reduced their alcohol intake (p<0.001). Alcohol abstinence during the 12 weeks of treatment did not differ between the four groups at the end of treatment. Craving for SO did not significantly differ amongst groups; cases of SO abuse were very limited and were observed in almost 10% of patients. In conclusion, our study showed an overall efficacy of SO in the treatment of AD irrespective of LAT categories. However, our results confirm that alcoholics with Psychiatric Co-Morbidity, particularly with a borderline personality ...
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients with and without Psychiatric comorbidity
European Neuropsychopharmacology, 2011Co-Authors: Fabio Caputo, Giovanni Addolorato, Lorenzo Leggio, Sara Francini, R Brambilla, Michela Stoppo, Arfedele Del Re, Federica Vignataglianti, Giorgio ZoliAbstract:Sodium oxybate (SMO) is a GABA-ergic drug currently used for the treatment of alcohol-dependence in some European countries. In particular, clinical studies have shown a role of SMO in promoting alcohol abstinence, as well as in relieving withdrawal symptoms. The aim of this study was to describe alcohol abstinence and the onset of craving for and abuse of SMO in alcohol-dependent subjects with and without Psychiatric Co-Morbidity. Forty-eight patients were enrolled and classified into two groups: group A (20 alcoholics without any Psychiatric Co-Morbidity) and group B (28 alcoholics with a Psychiatric Co-Morbidity). All patients were treated with oral SMO (50 mg/kg of body weight t.i.d.) for 12 weeks. Alcohol abstinence as well as alcohol drinking during the 12 weeks of treatment did not differ between the two groups at the end of treatment (p=0.9). In addition, a reduction of alcohol intake in both groups has been observed (p<0.0001). On the other hand, craving for SMO was significantly more frequent in group B than group A (p=0.001). Cases of SMO abuse were observed in almost 10% of group B patients. In conclusion, alcohol abstinence achieved through SMO administration does not differ in patients with and without Psychiatric Co-Morbidity. However, alcoholics with co-morbid borderline disorders appear to be at high risk of developing craving for and abuse of the drug; therefore, SMO may not be indicated in these patients.
Giovanni Addolorato - One of the best experts on this subject based on the ideXlab platform.
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients according to lesch typologies a pilot study
Journal of Psychopharmacology, 2014Co-Authors: Fabio Caputo, Giovanni Addolorato, R Brambilla, Arfedele Del Re, Giorgio Zoli, Federica Vignataglianti, Alice Grignaschi, Teo Vignoli, Mauro Cibin, Mauro BernardiAbstract:Sodium oxybate (SO) is a γ-amino-butyric acid (GABA)-ergic drug currently used for the treatment of alcohol dependence (AD) in some European countries. The aim of this study was to describe the effect of SO administration in alcoholics classified according to Lesch alcoholism typology (LAT). Forty-eight patients were enrolled and classified into four groups according to LAT. All patients were treated with oral SO (50 mg/kg of body weight t.i.d.) for 12 weeks. All patients significantly reduced their alcohol intake (p<0.001). Alcohol abstinence during the 12 weeks of treatment did not differ between the four groups at the end of treatment. Craving for SO did not significantly differ amongst groups; cases of SO abuse were very limited and were observed in almost 10% of patients. In conclusion, our study showed an overall efficacy of SO in the treatment of AD irrespective of LAT categories. However, our results confirm that alcoholics with Psychiatric Co-Morbidity, particularly with a borderline personality ...
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients with and without Psychiatric comorbidity
European Neuropsychopharmacology, 2011Co-Authors: Fabio Caputo, Giovanni Addolorato, Lorenzo Leggio, Sara Francini, R Brambilla, Michela Stoppo, Arfedele Del Re, Federica Vignataglianti, Giorgio ZoliAbstract:Sodium oxybate (SMO) is a GABA-ergic drug currently used for the treatment of alcohol-dependence in some European countries. In particular, clinical studies have shown a role of SMO in promoting alcohol abstinence, as well as in relieving withdrawal symptoms. The aim of this study was to describe alcohol abstinence and the onset of craving for and abuse of SMO in alcohol-dependent subjects with and without Psychiatric Co-Morbidity. Forty-eight patients were enrolled and classified into two groups: group A (20 alcoholics without any Psychiatric Co-Morbidity) and group B (28 alcoholics with a Psychiatric Co-Morbidity). All patients were treated with oral SMO (50 mg/kg of body weight t.i.d.) for 12 weeks. Alcohol abstinence as well as alcohol drinking during the 12 weeks of treatment did not differ between the two groups at the end of treatment (p=0.9). In addition, a reduction of alcohol intake in both groups has been observed (p<0.0001). On the other hand, craving for SMO was significantly more frequent in group B than group A (p=0.001). Cases of SMO abuse were observed in almost 10% of group B patients. In conclusion, alcohol abstinence achieved through SMO administration does not differ in patients with and without Psychiatric Co-Morbidity. However, alcoholics with co-morbid borderline disorders appear to be at high risk of developing craving for and abuse of the drug; therefore, SMO may not be indicated in these patients.
R Brambilla - One of the best experts on this subject based on the ideXlab platform.
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients according to lesch typologies a pilot study
Journal of Psychopharmacology, 2014Co-Authors: Fabio Caputo, Giovanni Addolorato, R Brambilla, Arfedele Del Re, Giorgio Zoli, Federica Vignataglianti, Alice Grignaschi, Teo Vignoli, Mauro Cibin, Mauro BernardiAbstract:Sodium oxybate (SO) is a γ-amino-butyric acid (GABA)-ergic drug currently used for the treatment of alcohol dependence (AD) in some European countries. The aim of this study was to describe the effect of SO administration in alcoholics classified according to Lesch alcoholism typology (LAT). Forty-eight patients were enrolled and classified into four groups according to LAT. All patients were treated with oral SO (50 mg/kg of body weight t.i.d.) for 12 weeks. All patients significantly reduced their alcohol intake (p<0.001). Alcohol abstinence during the 12 weeks of treatment did not differ between the four groups at the end of treatment. Craving for SO did not significantly differ amongst groups; cases of SO abuse were very limited and were observed in almost 10% of patients. In conclusion, our study showed an overall efficacy of SO in the treatment of AD irrespective of LAT categories. However, our results confirm that alcoholics with Psychiatric Co-Morbidity, particularly with a borderline personality ...
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sodium oxybate in maintaining alcohol abstinence in alcoholic patients with and without Psychiatric comorbidity
European Neuropsychopharmacology, 2011Co-Authors: Fabio Caputo, Giovanni Addolorato, Lorenzo Leggio, Sara Francini, R Brambilla, Michela Stoppo, Arfedele Del Re, Federica Vignataglianti, Giorgio ZoliAbstract:Sodium oxybate (SMO) is a GABA-ergic drug currently used for the treatment of alcohol-dependence in some European countries. In particular, clinical studies have shown a role of SMO in promoting alcohol abstinence, as well as in relieving withdrawal symptoms. The aim of this study was to describe alcohol abstinence and the onset of craving for and abuse of SMO in alcohol-dependent subjects with and without Psychiatric Co-Morbidity. Forty-eight patients were enrolled and classified into two groups: group A (20 alcoholics without any Psychiatric Co-Morbidity) and group B (28 alcoholics with a Psychiatric Co-Morbidity). All patients were treated with oral SMO (50 mg/kg of body weight t.i.d.) for 12 weeks. Alcohol abstinence as well as alcohol drinking during the 12 weeks of treatment did not differ between the two groups at the end of treatment (p=0.9). In addition, a reduction of alcohol intake in both groups has been observed (p<0.0001). On the other hand, craving for SMO was significantly more frequent in group B than group A (p=0.001). Cases of SMO abuse were observed in almost 10% of group B patients. In conclusion, alcohol abstinence achieved through SMO administration does not differ in patients with and without Psychiatric Co-Morbidity. However, alcoholics with co-morbid borderline disorders appear to be at high risk of developing craving for and abuse of the drug; therefore, SMO may not be indicated in these patients.
