Mary Cowan

Bio: Mary Cowan is an academic researcher from South London and Maudsley NHS Foundation Trust. The author has contributed to research in topics: Anorexia nervosa (differential diagnoses) & Productivity. The author has an hindex of 2, co-authored 5 publications receiving 32 citations.

The therapeutic effect of physical activity in a day-hospital patient with anorexia nervosa.

Abstract: Many presentations of anorexia nervosa (AN) are characterised by frequent engagement in excessive physical exercise (PE) (Zunker et al. 2011). Therefore, the treatment of AN includes the restriction of PE, and in some severe cases individuals are prescribed bed rest (Moola et al. 2015). Clinical observation has highlighted that advice to completely refrain from physical activity often drives the compulsion to exercise secretly, serving only to reinforce the isolative and shameful experience of an eating disorder (ED). Likewise, clinicians can feel frustrated that advice to refrain from PE is not taken (Beumont et al. 1994). The majority of patients with AN experience loss of muscle mass (El Ghoch et al. 2017). For this reason, resistance training seems sensible to prevent muscle atrophy (Fernández-del-Valle et al. 2016). Additionally, PE has been shown to promote bone health (Santos et al. 2017) which is beneficial as AN is typically associated with low bone mass, impaired bone structure, and reduced bone strength; all of which contribute to increased fracture risk (Misra & Klibanski 2014). Alongside the physical health benefits, PE can help improve mood, quality of life and wellbeing (Moola et al. 2015). However, the research into PE in the treatment of AN is limited and there are no standardised guidelines (Zunker et al. 2011) despite considerable efforts on an international level (BSOE 2018). During such efforts, e.g. the Ersmus Plus project “Brighter Side of Exercise” (BSOE 2018) it has been repeatedly noticed that fitness trainers are often uncertain about the appropriateness of specific exercises for patients with AN.

Occupation-Focused Assessment in Eating Disorders: Preliminary Utility

Abstract: This paper examines the utility of an occupation-focused assessment, Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile), when providing services for people diagnosed...

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines

Abstract: A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.

Prediction of longer-term outcome of treatment-resistant depression in tertiary care

Abstract: Background Systematic studies on the outcome of treatment-resistant depression are scarce. Aims To describe the longer-term outcome and predictors of outcome in treatment-resistant depression. Method Out of 150 patients approached, 118 participants with confirmed treatment-resistant depression (unipolar, n = 77; bipolar, n = 27; secondary, n = 14) treated in a specialist in-patient centre were followed-up for between 8 and 84 months (mean = 39, s.d. = 22). Results The majority of participants attained full remission (60.2%), most of whom (48.3% of total sample) showed sustained recovery (full remission for at least 6 months). A substantial minority had persistent subsyndromal depression (19.5%) or persistent depressive episode (20.3%). Diagnosis of bipolar treatment-resistant depression and poorer social support were associated with early relapse, whereas strong social support, higher educational status and milder level of treatment resistance measured with the Maudsley Staging Method were associated with achieving quicker remission. Exploratory analysis of treatment found positive associations between treatment with a monoamine oxidase inhibitor (MAOI) in unipolar treatment-resistant depression and attaining remission at discharge and at final follow-up, and duloxetine use predicted attainment of remission at final follow-up. Conclusions Although many patients with treatment-resistant depression experience persistent symptomatology even after intensive, specialist treatment, most can achieve remission. The choice of treatment and presence of good social support may affect remission rates, whereas those with low social support and a bipolar diathesis should be considered at higher risk of early relapse. We suggest that future work to improve the long-term outcome in this disabling form of depression might focus on social interventions to improve support, and the role of neglected pharmacological interventions such as MAOIs.