title: The Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related Conditions (MOSAIC): Comparison of the Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) with specialist supportive clinical management (SSCM) in outpatients with broadly defined anorexia nervosa: A randomized controlled trial.
abstract: OBJECTIVE
  Anorexia nervosa (AN) in adults has poor outcomes, and treatment evidence is limited. This study evaluated the efficacy and acceptability of a novel, targeted psychological therapy for AN (Maudsley Model of Anorexia Nervosa Treatment for Adults; MANTRA) compared with Specialist Supportive Clinical Management (SSCM).
  
  
  METHODS
  One hundred forty-two outpatients with broadly defined AN (body mass index [BMI] ≤ 18.5 kg/m²) were randomly allocated to receive 20 to 30 weekly sessions (depending on clinical severity) plus add-ons (4 follow-up sessions, optional sessions with dietician and with carers) of MANTRA (n = 72) or SSCM (n = 70). Assessments were administered blind to treatment condition at baseline, 6 months, and 12 months after randomization. The primary outcome was BMI at 12 months. Secondary outcomes included eating disorders symptomatology, other psychopathology, neuro-cognitive and social cognition, and acceptability. Additional service utilization was also assessed. Outcomes were analyzed using linear mixed models.
  
  
  RESULTS
  Both treatments resulted in significant improvements in BMI and reductions in eating disorders symptomatology, distress levels, and clinical impairment over time, with no statistically significant difference between groups at either 6 or 12 months. Improvements in neuro-cognitive and social-cognitive measures over time were less consistent. One SSCM patient died. Compared with SSCM, MANTRA patients rated their treatment as significantly more acceptable and credible at 12 months. There was no significant difference between groups in additional service consumption.
  
  
  CONCLUSIONS
  Both treatments appear to have value as first-line outpatient interventions for patients with broadly defined AN. Longer term outcomes remain to be evaluated.
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Biostatistics, King's College London.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Magill
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Bethany
authors.initials: B
authors.lastname: Renwick
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Keyes
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Martha
authors.initials: M
authors.lastname: Kenyon
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Hannah
authors.initials: H
authors.lastname: Dejong
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Anna
authors.initials: A
authors.lastname: Lose
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Hannah
authors.initials: H
authors.lastname: Broadbent
authors.affiliation: Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital.
authors.forename: Rachel
authors.initials: R
authors.lastname: Loomes
authors.affiliation: Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital.
authors.forename: Huma
authors.initials: H
authors.lastname: Yasin
authors.affiliation: Mental Health Research Network North London Hub.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Watson
authors.affiliation: Mental Health Research Network North London Hub.
authors.forename: Shreena
authors.initials: S
authors.lastname: Ghelani
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Bonin
authors.affiliation: Eating Disorders Service, North East London NHS Foundation Trust.
authors.forename: Lucy
authors.initials: L
authors.lastname: Serpell
authors.affiliation: The Phoenix Wing, St Ann's Hospital, Tottenham.
authors.forename: Lorna
authors.initials: L
authors.lastname: Richards
authors.affiliation: The Phoenix Wing, St Ann's Hospital, Tottenham.
authors.forename: Eric
authors.initials: E
authors.lastname: Johnson-Sabine
authors.affiliation: Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital.
authors.forename: Nicky
authors.initials: N
authors.lastname: Boughton
authors.affiliation: Oxford Adult Eating Disorder Service, Cotswold House, Warneford Hospital.
authors.forename: Linette
authors.initials: L
authors.lastname: Whitehead
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beecham
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Eating Disorders, King's College London.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Department of Biostatistics, King's College London.
authors.forename: Sabine
authors.initials: S
authors.lastname: Landau
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000856:Anorexia Nervosa / Q000628:therapy*; D015992:Body Mass Index; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy / Q000379:methods*; D057566:Self Report; D012720:Severity of Illness Index; D016896:Treatment Outcome