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Predictors of Treatment Acceptance and Completion in Anorexia Nervosa
Implications for Future Study Designs
Katherine A. Halmi, MD;
W. Stewart Agras, MD;
Scott Crow, MD;
James Mitchell, MD;
G. Terence Wilson, PhD;
Susan W. Bryson, MA, MS;
Helena C. Kraemer, PhD
Arch Gen Psychiatry. 2005;62:776-781.
Context There have been very few randomized controlled treatment studies of anorexia nervosa.
Objective To evaluate factors leading to nonacceptance and noncompletion of treatment for 2 specific therapies and their combination in the treatment of anorexia nervosa.
Design Randomized prospective study.
Setting Weill-Cornell Medical Center, White Plains, NY; University of Minnesota, Minneapolis; and Stanford University, Stanford, Calif.
Patients One hundred twenty-two patients meeting DSM-IV criteria for anorexia nervosa.
Interventions Treatment with cognitive-behavioral therapy, fluoxetine hydrochloride, or their combination for 1 year.
Main Outcome Measures Dropout rate and acceptance of treatment (defined as staying in treatment at least 5 weeks).
Results Of the 122 randomized cases, 21 (17%) were withdrawn; the overall dropout rate was 46% (56/122) in the remaining patients. Treatment acceptance occurred in 89 (73%) of the 122 randomized cases. Of the 41 assigned to medication alone, acceptance occurred in 23 (56%). In the other 2 groups, acceptance rate was differentiated by high and low obsessive preoccupation scores (rates of 91% and 60%, respectively). The only predictor of treatment completion was high self-esteem, which was associated with a 51% rate of treatment acceptance.
Conclusion Acceptance of treatment and relatively high dropout rates pose a major problem for research in the treatment of anorexia nervosa. Differing characteristics predict dropout rates and acceptance, which need to be carefully studied before comparative treatment trials are conducted.
Author Affiliations: Department of Psychiatry, Weill Medical College of Cornell University, White Plains, NY (Dr Halmi); Department of Psychiatry, Stanford University, School of Medicine, Palo Alto, Calif (Drs Agras and Kraemer and Ms Bryson); Department of Psychiatry, University of Minnesota, School of Medicine, Minneapolis (Dr Crow); Neuropsychiatric Research Institute and Department of Neuroscience, University of North Dakota School of Medicine & Health Services, Fargo (Dr Mitchell); and Department of Psychology, Rutgers University, Piscataway, NJ (Dr Wilson).
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