Ongoing Research

The Huntercombe Group has provided essential funding towards ongoing research into the identification of the neuropsychological profile of eating disorders (the Ravello profile) for several years.

In 2003, at the 9th Annual Meeting of the Eating Disorders Research Society, Ravello, Italy, the idea of having a single battery to measure neuropsychological deficits in eating disorders was conceived. At a neuroscience special interest group, clinicians and researchers noted that a large amount of neuropsychological studies had been undertaken but the findings were very mixed. In order to make sense of these findings and to create a more reliable evidence base, a single battery of well-established and validated measures was required to assess if deficits consistently found in small studies of Anorexia Nervosa clustered together in a large cohort.

Since 2003, Ian Frampton and Bryan Lask (formally Medical Advisor to The Huntercombe Group) began to process the literature and pull together a series of neuropsychological tasks with part funding from The Huntercombe Group. In 2008, ethical approval was granted to conduct a study to investigate whether specific neuropsychological impairments consistently identified in the majority of those with Anorexia Nervosa, cluster together to form distinct cognitive profiles in this population, using well validated, standardised assessment procedures. The secondary aims of this research are to investigate whether any identified neuropsychological impairment clusters are associated with specific cognitive or behavioural symptoms of Anorexia Nervosa. In addition, this study aims to clarify whether any neuropsychological impairments remain following weight gain.

The study has developed into a multi-site, international study with 23 centres participating- 12 in the UK, eight in Norway as well as Brazil, Denmark, and Switzerland. All three Huntercombe eating disorder services have been involved since 2008 and have provided a significant volume of clinical data. To date, there are over 300 anorexia nervosa patients recruited into the project. It is hoped that recruitment will be finished by 2012.

The following papers have been published:

1. Rose, Davis, Frampton & Lask (2011). The Ravello Profile: Development of a global standard neuropsychological assessment for young people with anorexia nervosa. Clinical Child Psychology and Psychiatry 16 (2): 195-202. DOI:10.1177/1359104511401191

Abstract: Recent research suggests that neuropsychological factors may play an important role in the development and maintenance of anorexia nervosa. However, it has been difficult to draw firm conclusions because of the wide range of assessments and norms that have been used. The aim of the Ravello Profile is to define a common shared neuropsychological assessment battery that can be adopted by researchers and clinicians working with young people. We describe the background to the Ravello Profile and the process of developing it, before specifying the recommended tests. We present an illustrative case example and consider some of the potential clinical and research applications of the profile with young people suffering from anorexia nervosa.

http://ccp.sagepub.com/content/16/2/195.abstract

2. Rose, Frampton & Lask (2011). A case series investigating distinct neuropsychological profiles in children and adolescents with anorexia nervosa. European Eating Disorders Review. Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.1095.

Abstract: A number of specific deficits in neuropsychological functioning in anorexia nervosa (AN) have been identified. However, it is not known whether these specific deficits cluster together to form one or more clear neuropsychological profiles. We present a case series of nine participants who were recruited as part of a wider, ongoing investigation of the neuropsychological profile of eating disorders (the Ravello Profile). Results show that there was a wide range of different neuropsychological profiles at initial assessment. This suggests a spectrum of neuropsychological strengths and weaknesses that would otherwise be masked in a cohort analysis. It is anticipated that factor and cluster analytic studies will establish one or more common profiles of neuropsychological deficits in AN. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

http://onlinelibrary.wiley.com/doi/10.1002/erv.1095/abstract;jsessionid=C65411C67DCDE8F70857D27AB74847BE.d02t03

Cognitive Remediation Therapy (CRT) for Anorexia Nervosa (AN) is a promising intervention aimed at improving the characteristic neuropsychological deficits and associated thinking styles. CRT is believed to work by strengthening and refining neural circuits, and by learning and transferring new cognitive strategies to appropriate situations. It addresses the process of thinking rather than the content, thus helping patients develop a metacognitive awareness of their own thinking style.

All three Huntercombe Eating Disorder Services are involved in a study to investigate the effectiveness of CRT as a treatment for adolescent AN. Traditionally CRT has been delivered on an individual basis, but other modes are currently being explored including group format and family based CRT. The research is in Phase 1 – Proof of Concept stage.

The following paper is in press following research carried out at Huntercombe Hospital – Stafford:

1. Wood, Al-Khairulla, Lask (2011). Group cognitive remediation therapy for adolescents with anorexia nervosa. Clinical Child Psychology and Psychiatry 16 (2): 225-31.

Abstract: Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is a relatively new intervention and targets neuropsychological deficits, such as set shifting difficulties, weak central coherence and visuospatial deficits. To date there are no published descriptions of CRT for adolescents with AN. CRT has been traditionally delivered on an individual basis but other modalities are currently being explored. This paper describes the process of a 10-session course of group-based CRT for adolescents with AN. The nine participants, aged 13-19, were being treated on an inpatient service. Group-based CRT was well received by the participants, who reported it to be fun and useful. Clinical impressions suggest that this approach is a potentially useful addition to the treatment of this challenging population.

http://ccp.sagepub.com/content/16/2/225.abstract

Our Blackheath Brain Injury Rehabilitation Centre and Neurodisability Service has a longstanding relationship with Goldsmiths, University of London. The university’s MSc in Cognitive and Clinical Neuroscience was developed in partnership with our centre at Blackheath. During the course of the MSc, there are opportunities for some students to gain relevant clinical work experience through part-time/ sessional employment at our centre and to carry out clinical research for their dissertations. One research theme has provided several smaller research projects for the MSc students.

• “Anasognosia (unawareness) for memory disorders following brain damage.” The causes and mechanisms underling this phenomenon are still unclear. This study aims to validate new assessment tools and to investigate possible mechanisms responsible for lack of awareness.

The following paper was published last year:

1. Cocchini, Gregg, Beschin, Dean, Della Sala (2010). Vata-L: Visual-Analogue Test Assessing Anosognosia for Language Impairment. The Clinical Neuropsychologist, 24, 8, 1379 – 1399.

Abstract: Lack of awareness (anosognosia) for one's own language impairments has rarely been investigated, despite hampering language rehabilitation. Assessment of anosognosia by means of self-report is particularly complex, as a patient's language difficulties may seriously prevent or bias the assessment. Other methods, such as measures of self-correction and error detection, have provided valuable information, although they are an indirect form of assessment of anosognosia and are not exempt from methodological criticisms. In this study we report on a new tool, the VATA-L (Visual-Analogue Test for Anosognosia for Language impairment), geared at assessing explicit anosognosia for aphasia. The VATA-L compares the patient's self-evaluation with caregivers' evaluations of the patient's verbal communication abilities in a series of common situations. By means of non-verbal support and a system of check questions, this test minimizes some of the methodological limitations of existing diagnostic tools (e.g., structured interviews), enhancing reliability, and enabling assessment of patients with aphasia. Finally, normative data provided in the study allow a clearer interpretation of the patient's performance and facilitate assessment of anosognosia.

http://www.informaworld.com/smpp/content~content=a930102352~db=all~jumptype=rss

We have several ongoing research projects being conducted in collaboration with King’s College, London:

• “Internet Based Relapse Prevention in Anorexia Nervosa Patients.” This research involves patients at The Huntercombe Group’s three eating disorder hospitals: Edinburgh, Maidenhead and Stafford and is a randomised controlled trial assessing the efficacy of an internet-based relapse prevention programme in Anorexia Nervosa.
• “Service Utilisation and Alternative Care Pathways for Adolescents with Eating Disorders.” This research is based at The Huntercombe Hospital- Maidenhead and aims to identify different treatment models, or care pathways, that exist for adolescents with eating disorders across Greater London and parts of Surrey and Hampshire, and to examine the impact of these on treatment outcomes.
• “Community Rehabilitation services for people with long-term neurological conditions.” This study, based at the Group’s brain injury centre in Blackheath, will investigate the provision of community-based rehabilitation services for people with complex needs as a result of a long-term neurological condition.
• “A phenomenology study of decision-making capacity in different mental disorders.” This research, taking place at the Group’s Blackheath centre, aims to address how and should the notion of Mental Capacity be interpreted and applied in the context of psychiatric disorder. The goal of the research is both practical (to inform and improve practical assessments of capacity) and theoretical (to inform and enrich philosophical discussions about autonomy through the study of decision-making inability)
• “A Qualitative Study Exploring Brain Injury Patients’ Families Expectations of Neurological Rehabilitation.” This study investigates brain-injury patient’s families’ expectations and perceptions of neurological rehabilitation. The research aims to assist with the engagement of families and explore if families’ expectations of the service are met.

• “Everyday Executive Functioning in Individuals with Acquired Brain Injury: Evaluating the Ecological and Convergent Validity of Traditional, Life-like and Computerised Tests of Prospective Memory and Planning”. The project looks at the effect of brain injury on memory, specifically prospective memory- difficulties with remembering to do things in the future. It is often reported that individuals have problems with this type of memory following certain types of neurological illness or brain injury.
• “Rehabilitation of Executive Function deficits following Brain Injury: using Goal Management Training and Implementation Intentions to improve Prospective Memory”. Linked to the above study, this project will test the intervention of Goal Management Training combined with Implementation Intentions vs. Management training alone to rehabilitate deficits in prospective memory.
• “An investigation of biological ageing processes following head injury”. This pilot study will explore whether biological age, as opposed to chronological age, contributes to outcome after head injury. Biomarkers of cellular ageing will be taken to access whether head injury accelerates biological ageing, or predisposes to adverse health events.
• “Assessing the Validity and Reliability of The Glasgow Outcome at Discharge Scale (GODS) for Head Injury”. The GODS is an assessment of disability after head injury for use in an inpatient setting. This study will access the instrument’s validity and reliability.

We are also currently working in collaboration with the following universities/ organisations on the following research projects:

• “Eating Disorder Service Users and Service Providers Experience at Meal Times.” This piece of research in collaboration with Loughborough University is based on interviews with staff and patients at The Huntercombe Hospital-Edinburgh. Information is being gathered directly from members of eating disorders’ staff teams regarding the factors which they perceive to influence service users experience of mealtimes and from service users regarding the factors which influence their intake during mealtimes.

• The following paper was published earlier this year:

  Long, Wallis, Leung, Arcelus, & Meyer (2011) Mealtimes on eating disorder wards: A two-study investigation. International Journal of Eating Disorders doi: 10.1002/eat.20916. [Epub ahead of print]

  Abstract: This research had two aims. First, to assess the current mealtime practices within UK eating disorders units. Second, to investigate staff perspectives of these mealtimes, including their involvement and understanding of patients' experience. Study 1 involved a survey to assess mealtime protocols across 22 eating disorders units. In Study 2, sixteen semi-structured interviews were conducted with staff at three eating disorders units. Between and within-unit variation exist regarding the implementation of mealtimes. Thematic analysis revealed that staff perceived their provision of mealtimes to be influenced by their own interpersonal difficulties created by the meals. Additionally, they perceived that these issues could be aided by forward planning, successful teamwork, and focused staff training. There is a need for specialized mealtime implementation training. Furthermore, research is required to evaluate current mealtime practices from patient perspectives and to determine the impact of modified mealtime approaches on treatment outcome.

  http://onlinelibrary.wiley.com/doi/10.1002/eat.20916/abstract

• “What is the effectiveness of balance re-education classes on balance impairments in individuals following acquired brain injury.” This piece of research, in conjunction with our brain injury centre in Murdostoun and Glasgow Caledonian University, aims to improve the management of balance impairments following acquired brain injury.
• “RAIN- Risk Adjustment in neurocritical care- prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care.” Blackheath Brain Injury Centre and the charity, Intensive Care National Audit and Research Centre, aim to improve the outcome and care given to patients who have suffered a traumatic brain injury with this study.
• “Anorexia Nervosa and The Treatment Environment.” Huntercombe Hospital Edinburgh and the University of Brighton are investigating patients’ experience of in-patient treatment environments for anorexia nervosa. The study aims to explore how people use and experience the space within a centre during in-patient treatment.

We hope that we will be publishing some of these research findings in the near future.