title: Clinical effectiveness of treatments for anorexia nervosa in adolescents: randomised controlled trial.
abstract: BACKGROUND
  Treatment guidelines identify few adequately powered trials to guide recommendations for anorexia nervosa.
  
  
  OBJECTIVE
  To evaluate the effectiveness of three readily available National Health Service treatments for adolescents (aged 12-18 years) with anorexia nervosa.
  
  
  METHODS
  Multicentre randomised controlled trial of 167 young people comparing in-patient, specialist out-patient and general child and adolescent mental health service (CAMHS) treatment.
  
  
  RESULTS
  Each group made considerable progress at 1 year, with further improvement by 2 years. Full recovery rates were poor (33% at 2 years, 27% still with anorexia nervosa). Adherence to in-patient treatment was only 50%. Neither in-patient nor specialist out-patient therapy demonstrated advantages over general CAMHS treatment by intention to treat, although some CAMHS out-patients were subsequently admitted on clinical grounds. In-patient treatment (randomised or after out-patient transfer) predicted poor outcomes.
  
  
  CONCLUSIONS
  First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.
authors.affiliation: Academic Unit, Section of Adolescent Psychiatry, University of Liverpool, Chester, UK. simon.gowers@cwpnt.nhs.uk
authors.forename: Simon G
authors.initials: SG
authors.lastname: Gowers
authors.forename: Andrew
authors.initials: A
authors.lastname: Clark
authors.forename: Chris
authors.initials: C
authors.lastname: Roberts
authors.forename: Alison
authors.initials: A
authors.lastname: Griffiths
authors.forename: Vanessa
authors.initials: V
authors.lastname: Edwards
authors.forename: Claudine
authors.initials: C
authors.lastname: Bryan
authors.forename: Nicola
authors.initials: N
authors.lastname: Smethurst
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.forename: Barbara
authors.initials: B
authors.lastname: Barrett
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003156:Community Mental Health Services / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods*; D004739:England; D005196:Family Therapy / Q000379:methods; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D013222:State Medicine / Q000458:organization & administration; D016896:Treatment Outcome