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: A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) medication does not appear to be effective in ill , malnourished anorexia nervosa ( AN ) patients . However , it may be effective in preventing relapse after weight restoration . The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects . METHOD Twenty-six subjects with AN participated in a trial of fluoxetine . In a double-blind , placebo-controlled manner , subjects received either nutritional supplements or a nutritional placebo . The nutritional supplement included tryptophan ( the precursor of serotonin ) , vitamins , minerals , and essential fatty acids believed to influence serotonin pathway function . RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo . Moreover , there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms . DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects Fifteen women with bulimia nervosa were treated with a 4-month course of combined cognitive-behavioral , nutritional and antidepressant therapy ( 5 with amineptine and 10 with fluvoxamine ) . Patients were monitored before and after 1 , 2 and 4 months of therapy for body mass index ( BMI ) , for eating disorder symptoms by the Eating Disorder Inventory ( EDI ) and the Bulimic Investigation Test ( BITE ) , and for depression and anxiety by the Hamilton Rating Scale for Depression and for Anxiety ( HRS-D and -A ) . BITE symptoms and gravity improved significantly and equally in the two groups during the 4 months of therapy . Global EDI scores , depression and anxiety decreased but not significantly . BMI was normal before therapy and did not change during treatment BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia OBJECTIVE To determine whether a grade d exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat . METHODS A r and omized controlled trial with outcome measures : change in percent body fat , body mass index ( BMI ) , and Medical Outcomes Survey Short Form 36-item Quality of Life question naire . RESULTS Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were r and omized . There was no difference in change in BMI or percent body fat at 3 months . Quality of life outcomes improved from baseline in the experimental group compared with the control group . However , this difference was not statistically significant . DISCUSSION Incorporation of a grade d exercise program may increase compliance with treatment , but it did not reduce the short-term rate of gain of body fat or BMI . Longer studies with more subjects are necessary to determine the usefulness of a grade d exercise program in anorexia nervosa OBJECTIVE Research suggests that family treatment for adolescents with anorexia nervosa may be effective . This study was design ed to determine the optimal length of such family therapy . METHOD Eighty-six adolescents ( 12 - 18 years of age ) diagnosed with anorexia nervosa were allocated at r and om to either a short-term ( 10 sessions over 6 months ) or long-term treatment ( 20 sessions over 12 months ) and evaluated at the end of 1 year using the Eating Disorder Examination ( EDE ) between 1999 and 2002 . RESULTS Although adequately powered to detect differences between treatment groups , an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups . Although a nonsignificant finding does not prove the null hypothesis , in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level . However , post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment . CONCLUSIONS A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short- duration anorexia nervosa . However , there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment There are no controlled studies of the long term impact of treatment on the evolution of anorexia nervosa , although it is clear that life can sometimes be saved in the short term and that a variety of pharma cological and behavioural approaches can have a short term and limited effect on the low body weight control mechanisms of the patient . During the past 20 years , the second author has run an established in patient combined  behaviour and psychotherapeutic treatment programme  for patients with anorexia nervosa involving restoration of body weight to matched population levels coupled with individual and family psychotherapy ( Crisp , 1967 ) . He believes that this approach does have an impact on the course of the disorder ( Crisp , 1980 ) . However , it is difficult to evaluate it in total in a controlled experimental fashion since , in the event , it is impossible to deny any patient a treatment which almost always has the short term . effect of her gaining weight back to normal adult levels . In recent years , therefore , an alternative strategy has developed in the unit in which specific treatments ( e.g. the impact of tricyclic drugs ( Lacey and Crisp , 1980 ) are experimentally superimposed on the basic treatment programme . This paper reports the impact of a social skills programme exhibited on this basis . Two case reports ( Lang , 1965 and Argyle et a ! , 1974a ) describe the efficacy of behavioural social anxiety treatment  for anorexia nervosa . These studies are limited in diag nostic detail . Wolpe ( 1975 ) advocates the value of the comprehensiveness of a behavioural analysis in treating anorexianervosathatwould includean assessment of the symptom of social anxiety within the clinical condition . A controlled study by Argyle et a ! ( 1974b ) indicates the efficiency of  social skills treat ment as well as brief psychotherapy in positively influencing social ease in a patient population . How ever , no experimental studies are reported on the impact of a behaviourally orientated treatment for social anxiety  on the course of recovery for anorexia nervosa . This treatment was introduced because anorectics are known to be socially isolated and to have low self-esteem ( Crisp , 1970 ; Pillay and Crisp , 1977 ) . Furthermore , previous follow-up studies have revealed that those who have recovered often become socially anxious despite their involvement in psycho therapy directed at this area of difficulty ( Stonehill and Crisp , 1977 ; Crisp , 1980 ) . The hypothesis was that social skills training within the established in-patient treatment programme would lead to a greater degree of recovery from anorexia nervosa at one year follow-up as measured by the percentage matched population mean weight of the patients , and furthermore that these patients would be less socially anxious than those who had not received suchtreatment The tricyclic antidepressant drug amitriptyline was evaluated as a short-term treatment of anorexia nervosa patients . In a 5-week double-blind , placebo-controlled study 11 patients were given amitriptyline and 14 received placebo .  In addition , 18 patients who refused to participate in the drug trial and received only psychosocial treatment were used as an additional comparison group . Overall , patients in the three groups showed little improvement . No statistically significant differences favoring amitriptyline were found in any of the outcome variables . Plasma levels varied widely among patients receiving similar doses . No association was found between plasma levels and improvement in either psychiatric symptomatology or weight .  Amitriptyline patients did not manifest any tendency for a reduction of depressive symptomatology . In addition , amitriptyline treatment was associated with substantial discomfort and adverse affects INTRODUCTION Anorexia nervosa ( AN ) still lacks a defined treatment . Since fluoxetine proved effective in weight-restored anorexics , this pilot study evaluates the efficacy of another SSRI , citalopram , in restricting-type AN . EXPERIMENTAL PROCEDURES Fifty-two female anorectic out patients were r and omized in the citalopram ( n=26 ) and waiting list ( n=26 ) as a control group .  Efficacy was assessed using Eating Disorder Inventory-2 , Eating Disorder Inventory-Symptom Checklist , State-Trait Anger Expression Inventory , Beck Depression Inventory , Symptom Checklist-90 and Structured Clinical Interview for DSM-IV Axis II Disorders . RESULTS Thirteen patients dropped-out , thus 19 patients received citalopram and 20 remained in the control group . After 3 months of treatment , the citalopram group showed a decrease on BDI and SCL-90 Depression subscale and an improvement of baseline obsessive compulsive features on SCL-90 , EDI-2 impulsiveness and Trait-anger on STAXI . Weight gain was similar in the two groups . DISCUSSION These preliminary results support the efficacy of citalopram in anorectics . Citalopram seems to improve depression , obsessive-compulsive symptoms , impulsiveness and Trait-anger Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a st and ard behavioural treatment , in the outpatient therapy of patients with anorexia nervosa . The two treatments were also compared with a control treatment procedure consisting of routine outpatient management .  Each group consisted of eight subjects . All the groups showed some improvement , but the findings did not provide support for the prediction that cognitive-behavioural treatment , design ed specifically to manipulate both attitudes and behaviour , was superior to the other types of treatment . The implication s of the findings are considered OBJECTIVE In anorexia nervosa ( AN ) , medical stabilization and nutritional repletion are pivotal steps toward physical and psychological recovery . Nutritional stabilization is often difficult in this patient group . Recombinant human growth hormone ( rhGH ) has been safely used as adjuvant therapy in other groups of malnourished patients . We hypothesize that rhGH treatment will hasten medical stabilization in AN patients . STUDY DESIGN Fifteen patients admitted for inpatient treatment for AN , ages 12 - 18 years , were enrolled in a 28-day r and omized , double-blind , placebo-controlled study . Patients received rhGH ( 0.05 mg/kg subcutaneously ) or an equivalent volume of placebo daily . Outcome measures included time to reach medical/cardiovascular stability , rate of weight gain , and duration of hospitalization . All patients received a st and ard refeeding protocol . RESULTS Mean admission body mass index was 14.5 kg/m2 . The rhGH and placebo groups did not differ significantly in admission weight , BMI or daily caloric intake . Patients treated with rhGH  reached medical/cardiovascular stability more rapidly than those treated with placebo ( median 17 vs. 37 days , p = 0.02 ) . Numerical but not statistically significant improvements were seen in weight gain and length of hospitalization in the rhGH group . CONCLUSION Patients treated with rhG 
    Output:
    
agent
Cognitive behavioral therapy may reduce relapse risk for adults with AN after weight restoration , although its efficacy in the underweight state remains unknown .
Variants of family therapy are efficacious in adolescents , but not in adults .
Evidence for AN treatment is weak ; evidence for treatment-related harms and factors associated with efficacy of treatment are weak ; and evidence for differential outcome by sociodemographic factors is nonexistent .
***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: A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) medication does not appear to be effective in ill , malnourished anorexia nervosa ( AN ) patients . However , it may be effective in preventing relapse after weight restoration . The purpose of this study was to determine whether nutritional supplements could potentiate the effects of fluoxetine in underweight AN subjects . METHOD Twenty-six subjects with AN participated in a trial of fluoxetine . In a double-blind , placebo-controlled manner , subjects received either nutritional supplements or a nutritional placebo . The nutritional supplement included tryptophan ( the precursor of serotonin ) , vitamins , minerals , and essential fatty acids believed to influence serotonin pathway function . RESULTS There was no significant difference in weight gain between subjects treated with fluoxetine plus nutritional supplements versus fluoxetine plus a nutritional placebo . Moreover , there were no significant differences between groups on mean changes in anxiety or obsessive and compulsive symptoms . DISCUSSION The results of this study suggest that supplement strategies are not a substitute for adequate nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight AN subjects Fifteen women with bulimia nervosa were treated with a 4-month course of combined cognitive-behavioral , nutritional and antidepressant therapy ( 5 with amineptine and 10 with fluvoxamine ) . Patients were monitored before and after 1 , 2 and 4 months of therapy for body mass index ( BMI ) , for eating disorder symptoms by the Eating Disorder Inventory ( EDI ) and the Bulimic Investigation Test ( BITE ) , and for depression and anxiety by the Hamilton Rating Scale for Depression and for Anxiety ( HRS-D and -A ) . BITE symptoms and gravity improved significantly and equally in the two groups during the 4 months of therapy . Global EDI scores , depression and anxiety decreased but not significantly . BMI was normal before therapy and did not change during treatment BACKGROUND Currently , without systematic evidence , psychotherapy for anorexia nervosa in adults draws on psychodynamic , cognitive and systemic theories . AIMS To assess effectiveness of specific psychotherapies in out-patient management of adult patients with anorexia nervosa . METHOD Eighty-four patients were r and omised to four treatments : three specific psychotherapies - ( a ) a year of focal psychoanalytic psychotherapy ; ( b ) 7 months of cognitive-analytic therapy ( CAT ) ; ( c ) family therapy for 1 year - and ( d ) low contact , ' routine ' treatment for 1 year ( control ) . RESULTS At 1 year , there was symptomatic improvement in the whole group of patients . This improvement was modest , several patients being significantly undernourished at follow-up . Psychoanalytic psychotherapy and family therapy were significantly superior to the control treatment ; CAT tended to show benefits . CONCLUSIONS Psychoanalytic and family therapy are of specific value in the out-patient treatment of adult patients with anorexia OBJECTIVE To determine whether a grade d exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat . METHODS A r and omized controlled trial with outcome measures : change in percent body fat , body mass index ( BMI ) , and Medical Outcomes Survey Short Form 36-item Quality of Life question naire . RESULTS Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were r and omized . There was no difference in change in BMI or percent body fat at 3 months . Quality of life outcomes improved from baseline in the experimental group compared with the control group . However , this difference was not statistically significant . DISCUSSION Incorporation of a grade d exercise program may increase compliance with treatment , but it did not reduce the short-term rate of gain of body fat or BMI . Longer studies with more subjects are necessary to determine the usefulness of a grade d exercise program in anorexia nervosa OBJECTIVE Research suggests that family treatment for adolescents with anorexia nervosa may be effective . This study was design ed to determine the optimal length of such family therapy . METHOD Eighty-six adolescents ( 12 - 18 years of age ) diagnosed with anorexia nervosa were allocated at r and om to either a short-term ( 10 sessions over 6 months ) or long-term treatment ( 20 sessions over 12 months ) and evaluated at the end of 1 year using the Eating Disorder Examination ( EDE ) between 1999 and 2002 . RESULTS Although adequately powered to detect differences between treatment groups , an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups . Although a nonsignificant finding does not prove the null hypothesis , in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level . However , post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment . CONCLUSIONS A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short- duration anorexia nervosa . However , there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment There are no controlled studies of the long term impact of treatment on the evolution of anorexia nervosa , although it is clear that life can sometimes be saved in the short term and that a variety of pharma cological and behavioural approaches can have a short term and limited effect on the low body weight control mechanisms of the patient . During the past 20 years , the second author has run an established in patient combined  behaviour and psychotherapeutic treatment programme  for patients with anorexia nervosa involving restoration of body weight to matched population levels coupled with individual and family psychotherapy ( Crisp , 1967 ) . He believes that this approach does have an impact on the course of the disorder ( Crisp , 1980 ) . However , it is difficult to evaluate it in total in a controlled experimental fashion since , in the event , it is impossible to deny any patient a treatment which almost always has the short term . effect of her gaining weight back to normal adult levels . In recent years , therefore , an alternative strategy has developed in the unit in which specific treatments ( e.g. the impact of tricyclic drugs ( Lacey and Crisp , 1980 ) are experimentally superimposed on the basic treatment programme . This paper reports the impact of a social skills programme exhibited on this basis . Two case reports ( Lang , 1965 and Argyle et a ! , 1974a ) describe the efficacy of behavioural social anxiety treatment  for anorexia nervosa . These studies are limited in diag nostic detail . Wolpe ( 1975 ) advocates the value of the comprehensiveness of a behavioural analysis in treating anorexianervosathatwould includean assessment of the symptom of social anxiety within the clinical condition . A controlled study by Argyle et a ! ( 1974b ) indicates the efficiency of  social skills treat ment as well as brief psychotherapy in positively influencing social ease in a patient population . How ever , no experimental studies are reported on the impact of a behaviourally orientated treatment for social anxiety  on the course of recovery for anorexia nervosa . This treatment was introduced because anorectics are known to be socially isolated and to have low self-esteem ( Crisp , 1970 ; Pillay and Crisp , 1977 ) . Furthermore , previous follow-up studies have revealed that those who have recovered often become socially anxious despite their involvement in psycho therapy directed at this area of difficulty ( Stonehill and Crisp , 1977 ; Crisp , 1980 ) . The hypothesis was that social skills training within the established in-patient treatment programme would lead to a greater degree of recovery from anorexia nervosa at one year follow-up as measured by the percentage matched population mean weight of the patients , and furthermore that these patients would be less socially anxious than those who had not received suchtreatment The tricyclic antidepressant drug amitriptyline was evaluated as a short-term treatment of anorexia nervosa patients . In a 5-week double-blind , placebo-controlled study 11 patients were given amitriptyline and 14 received placebo .  In addition , 18 patients who refused to participate in the drug trial and received only psychosocial treatment were used as an additional comparison group . Overall , patients in the three groups showed little improvement . No statistically significant differences favoring amitriptyline were found in any of the outcome variables . Plasma levels varied widely among patients receiving similar doses . No association was found between plasma levels and improvement in either psychiatric symptomatology or weight .  Amitriptyline patients did not manifest any tendency for a reduction of depressive symptomatology . In addition , amitriptyline treatment was associated with substantial discomfort and adverse affects INTRODUCTION Anorexia nervosa ( AN ) still lacks a defined treatment . Since fluoxetine proved effective in weight-restored anorexics , this pilot study evaluates the efficacy of another SSRI , citalopram , in restricting-type AN . EXPERIMENTAL PROCEDURES Fifty-two female anorectic out patients were r and omized in the citalopram ( n=26 ) and waiting list ( n=26 ) as a control group .  Efficacy was assessed using Eating Disorder Inventory-2 , Eating Disorder Inventory-Symptom Checklist , State-Trait Anger Expression Inventory , Beck Depression Inventory , Symptom Checklist-90 and Structured Clinical Interview for DSM-IV Axis II Disorders . RESULTS Thirteen patients dropped-out , thus 19 patients received citalopram and 20 remained in the control group . After 3 months of treatment , the citalopram group showed a decrease on BDI and SCL-90 Depression subscale and an improvement of baseline obsessive compulsive features on SCL-90 , EDI-2 impulsiveness and Trait-anger on STAXI . Weight gain was similar in the two groups . DISCUSSION These preliminary results support the efficacy of citalopram in anorectics . Citalopram seems to improve depression , obsessive-compulsive symptoms , impulsiveness and Trait-anger Ninety subjects with DSM-III-R anorexia nervosa were r and omly allocated to four treatment options , one inpatient , two outpatient , and one comprising an assessment interview only .  Twenty were thus offered a package of outpatient individual and family psychotherapy . At 2-year follow-up , 12 of the 20 were classed as well , or very nearly well , according to operationally defined criteria . Statistically significant improvements over time were obtained for weight , mean body mass index ( BMI ) , and also for psychological , sexual , and socioeconomic adjustments . Weight and BMI changes were significantly better than for the assessment only group , some of whom had received extensive treatment elsewhere . The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented . Lower weights at presentation and vomiting were associated with poorer outcome , although age and length of history were not This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a st and ard behavioural treatment , in the outpatient therapy of patients with anorexia nervosa . The two treatments were also compared with a control treatment procedure consisting of routine outpatient management .  Each group consisted of eight subjects . All the groups showed some improvement , but the findings did not provide support for the prediction that cognitive-behavioural treatment , design ed specifically to manipulate both attitudes and behaviour , was superior to the other types of treatment . The implication s of the findings are considered OBJECTIVE In anorexia nervosa ( AN ) , medical stabilization and nutritional repletion are pivotal steps toward physical and psychological recovery . Nutritional stabilization is often difficult in this patient group . Recombinant human growth hormone ( rhGH ) has been safely used as adjuvant therapy in other groups of malnourished patients . We hypothesize that rhGH treatment will hasten medical stabilization in AN patients . STUDY DESIGN Fifteen patients admitted for inpatient treatment for AN , ages 12 - 18 years , were enrolled in a 28-day r and omized , double-blind , placebo-controlled study . Patients received rhGH ( 0.05 mg/kg subcutaneously ) or an equivalent volume of placebo daily . Outcome measures included time to reach medical/cardiovascular stability , rate of weight gain , and duration of hospitalization . All patients received a st and ard refeeding protocol . RESULTS Mean admission body mass index was 14.5 kg/m2 . The rhGH and placebo groups did not differ significantly in admission weight , BMI or daily caloric intake . Patients treated with rhGH  reached medical/cardiovascular stability more rapidly than those treated with placebo ( median 17 vs. 37 days , p = 0.02 ) . Numerical but not statistically significant improvements were seen in weight gain and length of hospitalization in the rhGH group . CONCLUSION Patients treated with rhG 
    Output:
    