human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: IMPORTANCE Anorexia nervosa ( AN ) is a serious disorder with high rates of morbidity and mortality . Family-based treatment ( FBT ) is an evidence -based therapy for adolescent AN , but less than half of those who receive this approach recover . Hence , it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence -based treatment . OBJECTIVE To compare FBT with systemic family therapy ( SyFT ) for the treatment of adolescent-onset AN . DESIGN , SETTING , AND PARTICIPANTS Research in Anorexia Nervosa ( RIAN ) is a 2-group  ( FBT and SyFT ) r and omized trial conducted between September 2005 and April 2012 . Interviewers were blinded to the treatment condition . A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened . Of these , 262 adolescents did not meet the inclusion criteria and 138 declined to participate ; hence , 164 adolescents ( aged 12 - 18 years ) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , AN ( except for amenorrhea ) were enrolled . Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred . INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months . Family-based therapy focuses on the facilitation of weight gain , whereas SyFT addresses general family processes . MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight ( IBW ) and remission ( ≥95 % of IBW ) . The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment ( EOT ) . RESULTS There were no statistically significant differences between treatment groups for the primary outcome , for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up . Remission rates  included FBT , 33.1 % at the EOT and 40.7 % at follow-up and SyFT , 25.3 % and 39.0 % , respectively . Family-based therapy led to significantly faster weight gain early in treatment , significantly fewer days in the hospital , and lower treatment costs per patient in remission at the EOT ( FBT , $ 8963 ; SyFT , $ 18 005 ) . An exploratory moderator analysis found that SyFT led to greater weight gain  than did FBT for participants with more severe obsessive-compulsive symptoms . CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT . Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT . TRIAL REGISTRATION clinical trials.gov Identifier NCT00610753 BACKGROUND Habits are behavioral routines that are automatic and frequent , relatively independent of any desired outcome , and have potent antecedent cues . Among individuals with anorexia nervosa ( AN ) , behaviors that promote the starved state appear habitual , and this is the foundation of a recent neurobiological model of AN . In this proof-of-concept study , we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines . METHODS The primary intervention target was habit strength ; we also measured clinical impact via eating disorder psychopathology and actual eating . Twenty-two hospitalized patients with AN were r and omly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aim ed at cues for maladaptive behavioral routines , Regulating Emotions and Changing Habits ( REaCH ) . RESULTS Covarying for baseline , REaCH was associated with a significantly lower Self-Report Habit Index ( SRHI ) score and significantly lower Eating Disorder Examination- Question naire ( EDE-Q ) global score at the end-of-treatment . The end-of-treatment effect size for SRHI was d = 1.28 , for EDE-Q was d = 0.81 , and for caloric intake was d = 1.16 . CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy , and targeting habit strength yielded improvement in clinical ly meaningful measures . These findings support a habit-based model of AN , and suggest habit strength as a mechanism-based target for intervention OBJECTIVE Anorexia nervosa ( AN ) is a severe illness with high rates of relapse . Exposure and Response Prevention for AN ( AN-EXRP ) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety . The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration , at a pivotal moment when treatment goals shift toward relapse prevention . METHOD A r and omized controlled trial was conducted to compare AN-EXRP with a comparison condition , Cognitive Remediation Therapy ( CRT ) .  Hospitalized patients with AN ( n = 32 ) who had achieved weight restoration to a BMI > 18.5 kg/m(2 ) received 12 sessions of either AN-EXRP or CRT . Outcome was assessed by change in caloric intake in an objective assessment of eating behavior . RESULTS The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment , while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [ t(28 ) = 2.5 , p = .02 ] . Improvement in intake was significantly associated with improvement in eating-related anxiety ( Spearman 's ρ = 0.40 , p = .03 ) . DISCUSSION These data demonstrate that AN-EXRP , compared to a credible comparison intervention , is associated with better caloric intake in a laboratory meal over time in AN . Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinical ly significant change This study aim ed to determine predictors of BMI and recovery for out patients with anorexia nervosa ( AN ) . Patients were participants of the ANTOP ( Anorexia Nervosa Treatment of Out- Patients ) trial and r and omized to focal psychodynamic therapy ( FPT ) , enhanced cognitive behavior therapy ( CBT-E ) , or optimized treatment as usual ( TAU-O ) .  N=169 patients participated in the one-year follow-up ( T4 ) . Outcomes were the BMI and global outcome ( recovery/partial syndrome/full syndrome ) at T4 . We examined the following baseline variables as possible predictors : age , BMI , duration of illness , subtype of AN , various axis I diagnoses , quality of life , self-esteem , and psychological characteristics relevant to AN . Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome . The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients . Negative predictors for BMI and recovery were a duration of illness > 6 years and a lifetime depression diagnosis at baseline . Additionally , higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4 . A higher baseline BMI and shorter illness duration led to a better outcome . Further research is necessary to investigate whether or not AN patients with lifetime depression , higher bodily pain , and lower self-esteem may benefit from specific treatment approaches BACKGROUND Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor . Novel treatment approaches are urgently needed . AIMS To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa ( Maudsley Model of Anorexia Nervosa Treatment for Adults , MANTRA ) compared with specialist supportive clinical management ( SSCM ) in a r and omised controlled trial . METHOD Seventy-two adult out- patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK . Participants were r and omly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need ( trial registration : IS RCT N62920529 ) . The primary outcomes were body mass index , weight and global score on the Eating Disorders Examination at end of treatment ( 6 months ) and follow-up ( 12 months ) . Secondary outcomes included : depression , anxiety and clinical impairment ; neuropsychological outcomes ; recovery rates ; and additional service utilisation . RESULTS At baseline , patients r and omised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM ( 3/34 v. 10/36 ; P<0.05 ) . Patients in both treatments improved significantly in terms of eating disorder and other outcomes , with no differences between groups . Strictly defined recovery rates were low . However , MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM ( 7/34 v. 0/37 ; P = 0.004 ) . CONCLUSIONS Adults with anorexia nervosa are a difficult to treat group . The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM . This study confirms SSCM as a useful treatment for out- patients with anorexia nervosa . The novel treatment , MANTRA , design ed for this patient group may need adaptations to fully exploit its potential BACKGROUND In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high . Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home . We investigated the safety and efficacy of DP after short inpatient care compared with continued IP . METHODS For this multicentre , r and omised , open-label , non-inferiority trial , we enrolled female patients ( aged 11 - 18 years ) with anorexia nervosa from six centres in Germany . Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa . We used a computer-generated r and omisation sequence to r and omly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) . The treatment programme and treatment intensity in both study groups were identical . The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 0·75 kg/m(2 ) ) . Analysis was done by modified intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number Register , number IS RCT N67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 . FINDINGS Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we r and omly allocated to treatment : 85 to IP and 87 to DP . DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 0·46 kg/m(2 ) in favour of DP ( 95 % CI , -0·11 to 1·02 ; pnon-inferiority<0·0001 ) . The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) . Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP  attempted suicide 3 months after she was discharged . INTERPRETATION DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission . Thus , DP might be a safe and less costly alternative to IP . Our results justify the broad implementation of this approach . FUNDING German Ministry for Education and Research Background Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa , with a general consensus in the field that eating disorders focussed family therapy ( often referred to as Maudsley Family Therapy or Family Based Treatment ) currently offers the most promising outcomes . Nevertheless , a significant number do not respond well and additional treatment developments are needed to improve outcomes . Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first r and omised controlled trial of multifamily therapy for adolescent anorexia nervosa . Methods The study was a pragmatic multicentre r and omised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy ( MFT-AN ) and single family therapy ( FT-AN ) .  A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified ( restricting type ) were r and omised to the two treatments using computer generated blocks of r and om sizes to ensure balanced numbers in the trial arms . Independent assessors , blind to the allocation , completed evaluations at baseline , 3 months , 12 months ( end of treatment ) and 18 months . Results Both treatment groups showed clinical ly significant improvements with just 
    Output:
    
agent
There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: IMPORTANCE Anorexia nervosa ( AN ) is a serious disorder with high rates of morbidity and mortality . Family-based treatment ( FBT ) is an evidence -based therapy for adolescent AN , but less than half of those who receive this approach recover . Hence , it is important to identify other approaches to prevent the development of the chronic form of AN for which there is no known evidence -based treatment . OBJECTIVE To compare FBT with systemic family therapy ( SyFT ) for the treatment of adolescent-onset AN . DESIGN , SETTING , AND PARTICIPANTS Research in Anorexia Nervosa ( RIAN ) is a 2-group  ( FBT and SyFT ) r and omized trial conducted between September 2005 and April 2012 . Interviewers were blinded to the treatment condition . A total of 564 adolescents receiving care at 6 outpatient clinics experienced in the treatment of AN were screened . Of these , 262 adolescents did not meet the inclusion criteria and 138 declined to participate ; hence , 164 adolescents ( aged 12 - 18 years ) of both sexes meeting the criteria for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , AN ( except for amenorrhea ) were enrolled . Three participants were withdrawn from FBT and 7 were withdrawn from SyFT after serious adverse events occurred . INTERVENTIONS Two manualized family therapies with 16 one-hour sessions during 9 months . Family-based therapy focuses on the facilitation of weight gain , whereas SyFT addresses general family processes . MAIN OUTCOMES AND MEASURES The primary outcomes were percentage of ideal body weight ( IBW ) and remission ( ≥95 % of IBW ) . The a priori hypothesis was that FBT would result in faster weight gain early in treatment and at the end of treatment ( EOT ) . RESULTS There were no statistically significant differences between treatment groups for the primary outcome , for eating disorder symptoms or comorbid psychiatric disorders at the EOT or follow-up . Remission rates  included FBT , 33.1 % at the EOT and 40.7 % at follow-up and SyFT , 25.3 % and 39.0 % , respectively . Family-based therapy led to significantly faster weight gain early in treatment , significantly fewer days in the hospital , and lower treatment costs per patient in remission at the EOT ( FBT , $ 8963 ; SyFT , $ 18 005 ) . An exploratory moderator analysis found that SyFT led to greater weight gain  than did FBT for participants with more severe obsessive-compulsive symptoms . CONCLUSIONS AND RELEVANCE The findings of this study suggest that FBT is the preferred treatment for adolescent AN because it is not significantly different from SyFT and leads to similar outcomes at a lower cost than SyFT . Adolescents with more severe obsessive-compulsive symptoms may receive more benefits with SyFT . TRIAL REGISTRATION clinical trials.gov Identifier NCT00610753 BACKGROUND Habits are behavioral routines that are automatic and frequent , relatively independent of any desired outcome , and have potent antecedent cues . Among individuals with anorexia nervosa ( AN ) , behaviors that promote the starved state appear habitual , and this is the foundation of a recent neurobiological model of AN . In this proof-of-concept study , we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines . METHODS The primary intervention target was habit strength ; we also measured clinical impact via eating disorder psychopathology and actual eating . Twenty-two hospitalized patients with AN were r and omly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aim ed at cues for maladaptive behavioral routines , Regulating Emotions and Changing Habits ( REaCH ) . RESULTS Covarying for baseline , REaCH was associated with a significantly lower Self-Report Habit Index ( SRHI ) score and significantly lower Eating Disorder Examination- Question naire ( EDE-Q ) global score at the end-of-treatment . The end-of-treatment effect size for SRHI was d = 1.28 , for EDE-Q was d = 0.81 , and for caloric intake was d = 1.16 . CONCLUSIONS REaCH changed habit strength of maladaptive routines more than an active control therapy , and targeting habit strength yielded improvement in clinical ly meaningful measures . These findings support a habit-based model of AN , and suggest habit strength as a mechanism-based target for intervention OBJECTIVE Anorexia nervosa ( AN ) is a severe illness with high rates of relapse . Exposure and Response Prevention for AN ( AN-EXRP ) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety . The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration , at a pivotal moment when treatment goals shift toward relapse prevention . METHOD A r and omized controlled trial was conducted to compare AN-EXRP with a comparison condition , Cognitive Remediation Therapy ( CRT ) .  Hospitalized patients with AN ( n = 32 ) who had achieved weight restoration to a BMI > 18.5 kg/m(2 ) received 12 sessions of either AN-EXRP or CRT . Outcome was assessed by change in caloric intake in an objective assessment of eating behavior . RESULTS The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment , while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [ t(28 ) = 2.5 , p = .02 ] . Improvement in intake was significantly associated with improvement in eating-related anxiety ( Spearman 's ρ = 0.40 , p = .03 ) . DISCUSSION These data demonstrate that AN-EXRP , compared to a credible comparison intervention , is associated with better caloric intake in a laboratory meal over time in AN . Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinical ly significant change This study aim ed to determine predictors of BMI and recovery for out patients with anorexia nervosa ( AN ) . Patients were participants of the ANTOP ( Anorexia Nervosa Treatment of Out- Patients ) trial and r and omized to focal psychodynamic therapy ( FPT ) , enhanced cognitive behavior therapy ( CBT-E ) , or optimized treatment as usual ( TAU-O ) .  N=169 patients participated in the one-year follow-up ( T4 ) . Outcomes were the BMI and global outcome ( recovery/partial syndrome/full syndrome ) at T4 . We examined the following baseline variables as possible predictors : age , BMI , duration of illness , subtype of AN , various axis I diagnoses , quality of life , self-esteem , and psychological characteristics relevant to AN . Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome . The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients . Negative predictors for BMI and recovery were a duration of illness > 6 years and a lifetime depression diagnosis at baseline . Additionally , higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4 . A higher baseline BMI and shorter illness duration led to a better outcome . Further research is necessary to investigate whether or not AN patients with lifetime depression , higher bodily pain , and lower self-esteem may benefit from specific treatment approaches BACKGROUND Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor . Novel treatment approaches are urgently needed . AIMS To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa ( Maudsley Model of Anorexia Nervosa Treatment for Adults , MANTRA ) compared with specialist supportive clinical management ( SSCM ) in a r and omised controlled trial . METHOD Seventy-two adult out- patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK . Participants were r and omly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need ( trial registration : IS RCT N62920529 ) . The primary outcomes were body mass index , weight and global score on the Eating Disorders Examination at end of treatment ( 6 months ) and follow-up ( 12 months ) . Secondary outcomes included : depression , anxiety and clinical impairment ; neuropsychological outcomes ; recovery rates ; and additional service utilisation . RESULTS At baseline , patients r and omised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM ( 3/34 v. 10/36 ; P<0.05 ) . Patients in both treatments improved significantly in terms of eating disorder and other outcomes , with no differences between groups . Strictly defined recovery rates were low . However , MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM ( 7/34 v. 0/37 ; P = 0.004 ) . CONCLUSIONS Adults with anorexia nervosa are a difficult to treat group . The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM . This study confirms SSCM as a useful treatment for out- patients with anorexia nervosa . The novel treatment , MANTRA , design ed for this patient group may need adaptations to fully exploit its potential BACKGROUND In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high . Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home . We investigated the safety and efficacy of DP after short inpatient care compared with continued IP . METHODS For this multicentre , r and omised , open-label , non-inferiority trial , we enrolled female patients ( aged 11 - 18 years ) with anorexia nervosa from six centres in Germany . Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa . We used a computer-generated r and omisation sequence to r and omly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) . The treatment programme and treatment intensity in both study groups were identical . The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 0·75 kg/m(2 ) ) . Analysis was done by modified intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number Register , number IS RCT N67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 . FINDINGS Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we r and omly allocated to treatment : 85 to IP and 87 to DP . DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 0·46 kg/m(2 ) in favour of DP ( 95 % CI , -0·11 to 1·02 ; pnon-inferiority<0·0001 ) . The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) . Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP  attempted suicide 3 months after she was discharged . INTERPRETATION DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission . Thus , DP might be a safe and less costly alternative to IP . Our results justify the broad implementation of this approach . FUNDING German Ministry for Education and Research Background Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa , with a general consensus in the field that eating disorders focussed family therapy ( often referred to as Maudsley Family Therapy or Family Based Treatment ) currently offers the most promising outcomes . Nevertheless , a significant number do not respond well and additional treatment developments are needed to improve outcomes . Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first r and omised controlled trial of multifamily therapy for adolescent anorexia nervosa . Methods The study was a pragmatic multicentre r and omised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy ( MFT-AN ) and single family therapy ( FT-AN ) .  A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified ( restricting type ) were r and omised to the two treatments using computer generated blocks of r and om sizes to ensure balanced numbers in the trial arms . Independent assessors , blind to the allocation , completed evaluations at baseline , 3 months , 12 months ( end of treatment ) and 18 months . Results Both treatment groups showed clinical ly significant improvements with just 
    Output:
    