S-19-01

Risk factors for eating disorders (genetics and environment)

A. Karwautz, F. Fernandez-Aranda, G. Wagner, D. Collier, J. Treasure, A. Karwautz, AKH Wien, Wien, Austria

Objective: We present evidence about risk factor research findings in eating disorders in particular anorexia nervosa. Recent efforts have been made both longitudinally and retrospectively to understand the aetiology of these severe psychiatric disorders.

Methods: This includes studies using biological (e.g. molecular genetics), psychological (e.g. behaviour genetics), and psychosocial research strategies.

Results: Beside an outline about factors of risk (in particular for bulimia and anorexia nervosa and disordered eating), very recent results from studies using behaviour genetic methodology (discordant sister-pair designs) will be presented.

Conclusion: Risk factor research has been growing within the last decade and produces new insight into the etiology of these disorders in order to inform patients, families correctly and develop more precise prevention programs.

S-19-02

Pyschotherapy of eating disorders

F. Fernandez-Aranda. University Hospital of Bellvit, Barcelona, Spain

Objective: The aim of this presentation is to give an overview of the current evidence-based psychotherapies for bulimia and anorexia nervosa.

Methods: A systematic review of the literature (MEDLINE; EMBASE; PsycLIT; Current Contents; The Cochrane Library) was carried out, to determine the most effective therapies for EDs.

Results: Various studies have been conducted on Eating Disorders, which have demonstrated the effectiveness of different therapeutical approaches, ranging from a psychodynamic to a cognitive-behavioural (CBT) treatment orientation. However, there is a lack of control trials in the literature, especially for Anorexia nervosa. Whereas, CBT and an interpersonal approach have been found to be effective in the treatment for Bulimia nervosa, as demonstrated in some open controlled studies, the results for Anorexia nervosa seem to be unclear. In the later, family therapy seems to be a valuable part of treatment, particularly in the case of children and adolescents, but no specific approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Looking at the predictor, therapy outcome, it is not clear which factors enhance or reduce this effectiveness. Better results seem to be related to a longer duration of the therapy with the addition of other treatment components and a lower purging symptomatology.

Conclusion: Conclusions about the efficacy of specific treatments in AN, it is difficult to draw. In this disorder, controlled trials are few and their quality poor. In the case of BN, where several controlled trials have been conducted, CBT and Interpersonal therapy have shown to be effective. In both disorders, much more research is required. Supported by FIS (G03-184)

S-19-03

What we know and what we don't know about the pharmacotherapy of eating disorders

A. Favaro. Psychiatric Clinic Padova, Padova, Italy

Objective: The evidence for the effectiveness of specific drugs in ED is still limited, particularly for anorexia nervosa. Methods: A comprehensive systematic review of the literature on psychopharrnacology of eating disorders was performed.

Results: In anorexia nervosa, important methodological and ethical issues limit the possibility of conducting drug effectiveness studies. Indeed, there is a high rate of patients who refuse the treatment; other patients must be excluded from clinical trials because of the presence of severe medical complications; finally, some others drop out during the trial. Most available studies are performed in inpatient settings and the interaction between the use of drugs, the use of other treatments (nutritional rehabilitation and CBT), and the presence of other types of psychiatric symptoms, are very difficult to be disentangled. However, it would be very important to collect other data to find out which patients (and in which setting) might benefit from an adjuvant drug treatment. In bulimia nervosa (and, recently, in binge eating disorder) more double-blind controlled studies are available. However, a lot of important questions remain to be solved even for these patients. The long-term effectiveness of antidepressant drugs is not demonstrated and the rate of full responders is still too low. The role of individual factors, such as personality, comorbidity and other prognostic factors is not known.

Conclusion: Further studies are necessary to understand which is the best way to individualize treatment in a clinical evidence based way.

S-19-04

Prevention of eating disorders

M. M. Fichter. Klinik Roseneck aff Uni MUC, Prien, Germany

The prevalence of anorexic and bulimic eating disorders is relatively high in young women and has increased in prevalence since the 1970s. Anorexia nervosa has a high chronicity rate and the mortality rate is among the highest of all psychiatric disorders. The alms of prevention of eating disorders is the early detection and the reduction of factors which increase the risk for the onset of an eating disorder. Possible risk factors are dieting, body dissatisfaction and thoughts centred around body weight and one's own figure and poor self-esteem. Primary prevention is aimed at reducing the incidence of eating disorders and it addresses clinically healthy persons. Secondary prevention addresses populations with an increased risk such as ballet dancers and persons pursuing certain weight-related sports (ski-jumping, jockeys). Tertiary prevention deals with individuals who have an eating disorder and interventions are aimed at reducing symptomatology and preventing relaps. Most research on the prevention of eating disorders aim at groups with a higher risk to develop an eating disorder (such as female gender, adolescents) or mediators (parents, teachers, doctors). Means of prevention are usually psycho-education, information about the illness and possibilities for help and treatment. In recent years several relevant empirical studies on the prevention of eating disorders have been carried out. The paper reviews these studies and discusses various risk factors for the development of an eating disorder and critically evaluates different strategies for prevention.