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S184

24th European Congress of Psychiatry / European Psychiatry 33S (2016) S116–S348

EW203

Randomized controlled trial testing

behavioral weight loss versus

multi-modal stepped-care treatment

for binge eating disorder

C. Grilo

Yale University School of Medicine, Psychiatry, New Haven, USA

Introduction

Binge eating disorder (BED) is prevalent, associated

with obesity and elevated psychiatric co-morbidity, and represents

a treatment challenge.

Objective and aims

A controlled comparison of multi-modal,

stepped-care versus behavioral-weight-loss (BWL) for BED.

Methods

One hundred and ninety-one patients (71% female,

79% white) with BED and co-morbid obesity (mean BMI 39)

were randomly assigned to 6 months of BWL (

n

= 39) or stepped-

care (

n

= 152). Within stepped-care, patients started BWL for

one month; treatment-responders continued BWL while non-

responders switched to cognitive-behavioral-therapy (CBT) and

all stepped-care patients were additionally randomized to anti-

obesity medication or placebo (double-blind) for five months.

Independent assessmentswere performed by research-clinicians at

baseline, throughout treatment, and post-treatment (90% assessed)

with reliably-administered structured interviews.

Results

Intent-to-treat analyses of remission rates (0

binges/month) revealed BWL and stepped-care did not differ

significantly overall (74% vs 64%); within stepped-care, remission

rates differed (range 40% - 79%) with medication significantly

superior to placebo (

P

< 0.005) and among initial non-responders

switched to CBT (

P

< 0.002). Mixed-models analyses of binge eating

frequency revealed significant time effects but BWL and stepped-

care did not differ overall; within stepped-care, medication was

significantly superior to placebo overall and among initial non-

responders switched to CBT. Mixed models revealed significant

weight-loss but BWL and stepped-care did not differ overall;

within stepped-care, medication was significantly superior to

placebo overall and among both initial responders continued on

BWL and non-responders switched to CBT.

Conclusions

Overall, BWL and stepped-care treatments produced

improvements in binge-eating and weight loss in obese BED

patients. Anti-obesity medication enhanced outcomes within a

stepped-care model.

Disclosure of interest

The author has not supplied his/her decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.321

EW204

Binge-eating disorder and major

depressive disorder co-morbidity:

Sequence and clinical significance

C. Grilo

1 ,

, D. Becker

2

1

Yale University School of Medicine, Psychiatry, New Haven, USA

2

University California- San Francisco, Psychiatry, San Francisco, USA

Corresponding author.

Introduction

Binge-eating disorder (BED) is associated with obe-

sity and with elevated rates of co-occurring major depressive

disorder (MDD) but the significance of the diagnostic comorbid-

ity is ambiguous—as is the significance of the onset sequence for

MDD and BED.

Objective and aims

We compared eating-disorder psychopathol-

ogy and psychiatric comorbidity in three subgroups of BED

patients: those inwhomonset of BEDpreceded onset of MDD, those

with onset of MDD prior to onset of BED, and those without MDD

or any psychiatric comorbidity.

Methods

A consecutive series of 731 treatment-seeking patients

meetingDSM-IV-TR research criteria for BEDwere assessed reliably

by doctoral-clinicians with semi-structured interviews to evaluate

lifetime psychiatric disorders (SCID-I/P) and ED psychopathology

(EDE Interview).

Results

Based on SCID-I/P, 191 (26%) patients had onset of BED

preceding onset of MDD, 114 (16%) had onset of MDD preceding

onset of BED, and 426 (58%) had BED without co-occurring dis-

orders. Three groups did not differ with respect to age, ethnicity,

or education, but a greater proportion of the group without MDD

was male. Three groups did not differ in body-mass-index or binge-

eating frequency, but groups differed significantly with respect to

eating-disorder psychopathology, with both MDD groups having

significantly higher levels than the group without co-occurring dis-

orders. The group having earlier onset of MDD had elevated rates

of anxiety disorders compared to the group having earlier onset of

BED.

Conclusions

MDD in combination with BED—with either order of

onset—has a meaningful adverse effect on ED psychopathology and

overall psychiatric co-morbidity.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.322

EW205

ARFID in adults: Problems with the

DSM 5 and ICD-11 conceptualization

of restrictive eating disorders

R. Gupta

, V. Krishnan , K.S. Deb , A. Mahapatra , P. Sharan

All India Institute of Medical Sciences, Psychiatry, New Delhi, India

Corresponding author.

Introduction

The nosology of eating disorders is undergoing a

vast change. As a part of the revision process, the new diagnos-

tic category of “Avoidant/Restrictive Food Intake Disorder” (ARFID)

replaces the “Feeding Disorder of Infancy or Early Childhood” of

DSM-IV to include those patients who have restrictive patterns of

diet, but do not endorse weight or body shape concerns as the pri-

mary reasons for these restrictions. DSM-5 broadened the scope of

ARFID to also include adults with restrictive eating patterns, which

cannot be explained otherwise.

Aims & objectives

To highlight the nosological issues with ARFID

as a diagnosis among adults.

Methods

A case series describing four cases presenting with dis-

ordered eating causing significant dysfunction that occurred for the

first time in adulthood.

Results

In each case, anxieties regarding the consequences of

eating multiple types of food led to significant restrictions of the

quantity or kinds of diet which was associated with distress and

dysfunction, and, significant weight loss. However, in all the cases,

the restriction was secondary to the fear of physical symptoms

which could be explained by underlying ICD-10 somatoform dis-

order. The cases do not match the classic western description of

ARFID.

Conclusions

This series highlights some of the issues relating

to eating disorder, particularly its clinical and nosological status.

Problems relating to classification in a non-western setting are

also reflected by the difficulty in labeling eating-related problems

amidst the interplay of somatization, culture and eating.

Disclosure of interest

The authors have not supplied their decla-

ration of competing interest.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.323

EW206

Changes in the electrical properties of

the tissues in patients with anorexia

nervosa measured by bioelectrical

impedance analysis

H. Karakula-Juchnowicz

1 ,

, M. Teter

2

, G. Kozak

3

,

A. Makarewicz

3

, J. Kalinowska

3

, T. Małecka-Massalska

2