To assess whether early intervention improves the outcome of patients with anorexia nervosa.

Relevant studies were located by searching PsycLIT, MEDLINE, published reviews of anorexia, and the reference lists of retrieved articles. No effort was made to locate unpublished material.

Study designs of evaluations included in the review

Retrospective and prospective case studies were included.

Specific interventions included in the review

The author does not state the specific interventins used to treat patients.

Participants included in the review

Patients diagnosed with anorexia nervosa, who had received no previous treatment for the illness, were included.

Outcomes assessed in the review

The outcome assessed was the duration of illness between assessment and follow-up.

How were decisions on the relevance of primary studies made?

The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection. The studies had to meet predefined selection criteria: a minimum of 15 patients; patients had to meet explicit diagnostic criteria for anorexia nervosa; sufficient information had to be stated regarding age of onset, age of admission, and duration of illness; there should have been no previous treatment for anorexia; the period patients were admitted to the study had to be less than 20 years; mean follow-up time had to be at least 2 years after admission; less than a 20-year range of follow-up; selective withdrawals had to be avoided (65% of admissions were required to complete the study); use of multiple and well-defined criteria for the evaluation of treatment outcome.

Some of the inclusion criteria also acted as validity criteria, namely: selective withdrawals had to be avoided (65% of admissions were required to complete the study); use of multiple and well-defined criteria for the evaluation of treatment outcome; and follow-up. The author does not state how the papers were assessed for validity, or how many of the reviewers performed the validity assessment.

The author does not state how the data were extracted for the review, or how many of the reviewers performed the data extraction.

How were the studies combined?

The studies were combined through a narrative discussion.

How were differences between studies investigated?

Differences between the studies were investigated through a narrative discussion.

Six studies of 294 females and 17 males were included.

In 4 of the 6 studies the duration of illness was not related to the treatment outcome. In the 2 remaining studies, a negative relationship between duration of illness and the outcome of treatment was reported.

The prognostic value of early intervention in anorexia nervosa cannot be estimated on the basis of the treatment outcome literature. Unfortunately, the duration of illness and not the occurrence of early intervention is considered in most of the outcome studies. In addition, a number of methodological shortcomings make it impossible to evaluate the prognostic value of early intervention.

An intriguing review of a particularly distressing illness. The author's approach to a systematic review appears novel in that he chose to first search review articles before approaching the electronic databases. Unfortunately, he fails to state what years were searched online and does not indicate the search strategy employed (the quality of a computerised search depends greatly on the method employed). Study details provided in the review are poor and there is no indication of the specific interventions used to treat the patients. Inevitably this review is hindered by the small number of studies meeting the selection criteria and the poor quality of these trials.

There is currently insufficient evidence to suggest that early intervention improves the prognosis in anorexia nervosa.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.