Table 1 Main features of the included articles
First author/ Year/ Country | Type of study | Treatment proposed | N. participants/ Diagnosis/ Mean BMI | Mean age/ Mean DD | Outcome measures | Main results |
|---|---|---|---|---|---|---|
Dalle Grave 2013 Italy | RCT | CBT | N = 80 AN BMI:14.3 | 23,4 5 | BMI | Most patients completed CBT, both groups showed improvements in weight and ED. No significant differences |
Calugi 2017 Italy | Longitudinal trial | CBT | N = 66 SE-AN BMI: 14.7 | 26.1 7.7 | BMI, EDE, GSI and BSI | Inpatient CBT-E achieved a significant increase in BMI, and substantial improvements in ED-specific and general psychopathology in both SE-AN and NSE-AN group of patients |
Frostad 2021 Norway | Quality Assessment | CBT | N = 21 SE-AN < 16 | 25,5 7,3 | BMI | At 1 year, 66.7% of patients had BMI > 18,5 kg/m2. Results» CBT-E as a valid alternative to hospitalization |
Touyz 2013 Australia e UK | RCT | CBT SSCM | N = 63 SE-AN 16,2 | 33,4 16,6 | Quality of life, Weight gain, ED symptoms | Both groups improved weight and EDE. CBT-AN had lower EDE scores at 12 months |
Le Grange 2014 UK, Australia | RCT | CBT SSCM | N = 63 SE-AN BMI:16.2 | 3,0.4 16,6 | EDQOL, MCS, BDI | CBT-AN was found to be more beneficial than SSCM for worse depression level, older age, more severe ED-related symptoms, AN-BP subtype |
Elbaky 2014 Australia USA | RCT | CBT SSCM | N = 63 SE-AN BMI:16 | NR 14 | EDE, EDQOL, SF, ANSOQ | Those who did not complete treatment» had restrictive AN subtype and worse EDEQOL |
Schwartz 2020 USA | Longitudinal trial | IM Ketamine | N = 4 AN or BN 17,5 < BMI < 37,8 | 36,7 > 7 | BDI, EDE-Q, BMI | IM Ketamine effective for depressive aspects in TRD and AN patients. Minor positive results in reducing ED symptoms. Reduced risk of suicide |
Andries 2014 Denmark | RCT | Dronabinol | N = 24 AN BMI NR Caucasian | > 18 > 5 | Weight, EDI-2, Leptin levels | Dronabinol gave a small weight improvement. No significant differences between Dronabinol and Placebo in changing ED symptoms |
Attia 2019 USA | RCT | Olanzapine | N = 152 SE-AN BMI: 16.8 | 29 11.55 | BMI and weight, YBOCS, EDE, CES-D, CGI severity scale, ZAI | Modest therapeutic effect of olanzapine versus placebo on weight gain in outpatients with AN, but no significant benefit for psychological symptoms |
Calabrese 2022 Italy | Pilot study | Therapeutic ketogenic diet/ Ketamine infusions | N = 5 SE-AN NR | 38.4 > 10 | BMI, CIA, EDEQ, Qualitative interviews | TKD followed by ketamine infusion treatment was both safe, effective and helpful in reducing AN-related psychopathology and symptoms. BMI did not significantly change |
Mauri 2013 Italy | Case reports | Haloperidol | N = 9 SE-AN-R BMI: 12.2 | 25.8 7.6 | Side effects, BMI, Severity of delusional symptoms | Low-dose haloperidol treatment was well-tolerated and useful in improving BMI, delusional body image disturbance and the drive for thinness in severe and treatment-resistant AN. No side effects reported |
Cassano 2003 Italy | Clinical Trial | Haloperidol | N = 13 SE-AN-R BMI: 15.7 | 22.8 6.3 | BMI, EDI, EAT, CGI-S and CGI-I | The use of haloperidol as an addiction therapy in SE-AN-R patients was associated with improvement of ED symptomatology and increased BMI after 6 months of treatment |
Israely 2017 Israel | Double-Blind, Randomized Cross-Over Trial | Tyrosine | N = 19 Severe AN BMI: 15.5 | 22.8 6.3 | CTBHPB, EDI-2, BDI, STAI, MPS, LOI | Tyrosine supplementation may improve cognitive function and psychological traits associated with AN (depression) |
Van den Eynde 2013 UK | Pilot study | rTMS | N = 10 AN 15,7 NR | 25 10 | EDE-Q, DASS-21 | Diminished feelings of “being fat” or “full” and anxiety |
Dalton 2021 UK | Pilot study | rTMS | N = 34 AN > 14 NR | NR > 3 | BMI, Clinical evaluation of depression and anxiety | No differences in regional CBF groups Amygdala-rTMS showed greater increase in weight |
Park 2018 USA | Longitudinal trial | DBS at NAcc | N = 6 SE-AN Range 13–16 | Range 21–65 > 7 | BMI Neuro-psychological/ behavioral measurements | Data will be included in future publications |
Martinez 2020 Spain | RCT | DBS at NAcc or SCC | N = 8 SE-AN Range 9,64–16,22 | Range 18–60 > 10 | BMI Changing in AN behaviors and clinical variants | BMI-RV defined as mean BMI over the last 12 months. After treatment 5 patients had significant BMI and QOL improvement |
Dalton 2018 UK | RCT | rTMS | N = 34 SE-AN 16 Caucasian | 29,74 14,07 | ED symptoms Mood/Psychopathology QOL | rTMS was safe and well tolerated. Small differences in BMI and ED-symptoms on QOL between the groups and moderate results for mood improvement |
Bartholdy 2015 UK | RCT | rTMS | N = 44 AN Range 14–18,5 | > 18 > 3 | EDE-Q + BMI Mood/Psychopathology QOL | Data will be included in future publications |
Dalton 2020 UK | RCT | rTMS | N = 30 AN BMI > 14 | NR NR | EDE-Q + BMI Mood/Psychopathology QOL | rTMS exerts long lasting effects on mood, but BMI and ED symptom improvement need more time |
Dalton 2022 UK | Qualitative study | rTMS | N = 29 SE-AN 16 | 30.1 15.1 | Qualitative interviews | rTMS produced changes in life such as becoming more positive and open‐minded, less anxious, more motivated, more flexible around food and more willing to try new things |
Lipsman 2017 USA | Open-label Trial | DBS of subcallosal cingulate | N = 16 SE-AN BMI: 12.3 | 34 18 | BMI, HAMD, BDI, BAI, YBOCS, YBC-EDS, DER, QOL, BIS/BAS, PET imaging | Subcallosal cingulate DBS was safe and well tolerated. It was related with significant and lasting improvements in mood, anxiety, affective regulation, BMI, and changes in neural activity |
McClelland 2016 UK | Case series | rTMS | N = 5 SE-AN BMI: 16.1 | 35.6 20.4 | BMI, EDE-Q, DASS-21 | rTMS was well tolerated and associated with improvements in ED and affective symptoms that persisted (at least partially) for 12 months |
Fernandes Arroteia 2020 Luxembourg | Case report | DBS of NAcc | N = 1 Bulimic SE-AN BMI:12.8 | 42 > 10 | BMI, Subjective QOL | After 1 year of DBS there was a report of impressive weight gain (15 kg) and subjective increase in QOL. No improvement in comorbid depression |
Guerrero Alzola 2020 Spain | Case report | Stereotactic cingulotomy | N = 1 AN-R BMI:12.8 | 46 31 | BMI, BSQ, EDI-2, SF-36, TONI-2, BDI-II, HADS, YBOCS | After a 10 year follow-up post stereotactic surgery, the patient is clinically stable with an increased BMI and improved neuropsychological indicators |