Abstract
Objective: Our aim is to present clinical results achieved with an intensive treatment programme for severe anorexia nervosa (AN) patients at risk of severe disability or death. Aims of the treatment are to remove life threatening conditions, physical and nutritional rehabilitation, and psychological and relational rehabilitation. Methods: We present an observational retrospective study of a cohort of 99 consecutive patients affected by severe AN [according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)] and a body mass index (BMI) =13.5 kg/m2 treated by a multidisciplinary comprehensive medical, nutritional, psychological treatment. Intensive treatment (inpatient day and night and day hospital care) of variable length, with resort to enteral nutrition if needed, ends by achieving a BMI of at least 18 kg/m2. Outpatient care phase follows. Main goals were the recovery of BMI and the ability to maintain it. Results: Ninety-nine patients affected by severe Protein- Energy-Malnutritrion (PEM) due to AN were eligible in the study. Mean BMI was 12.5±0.9 kg/m2, mean age 21.9±8.6 yrs. Of 99 patients, 75 (75.5%) completed the planned treatment (completer subgroup). Eighteen patients prematurely interrupted their treatment before achieving complete weight restoration (dropout subgroup); on average they were older and ill for a longer time before admission. Six patients asked to be transferred to other eating disorder units closer to their towns. Seventy-five completer AN patients continued to undergo intensive inpatient treatment till the achievement of BMI 18.3±0.8 kg/m2 and then they have been in follow-up outpatient for a mean period of 17.4±1.6 months with an average extra increase of their BMI until to 19.1±1.6 kg/m2. In 32 patients with a more severe malnutrition we had to resort to nasogastric enteral feeding for 4.4±2.5 months, with a mean caloric supply of 1375±211 Kcal until the patients were no longer at life risk and they started to co-operate to treatment, increasing oral food amounts. Discussion: Our results seem to provide strong support for using a highly structured program for treating patients with severe AN, including inpatient care and multidisciplinary medical and psychological teams specialized in eating disorder treatment.
Similar content being viewed by others
References
Hoek H.W.: Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr. Opin. Psychiatry, 19, 389–394, 2006.
Treasure J., Schmidt U.: Anorexia nervosa. Clin. Evid., 11, 1192–1203, 2004.
Ben-Tovim D.I., Walker K., Gilchrist P., Freeman R., Kalucy R., Esterman A.: Outcome in patients with eating disorders: a 5-year study. Lancet, 357, 1254–1257, 2001.
Beumont P., Hay P., Beumont D., Birmingham L., Derham H., Jordan A., Kohn M., McDermott B., Marks P., Mitchell J., Paxton S., Surgenor L., Thornton C., Wakefield A., Weigall S.: Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Anorexia Nervosa: Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa. Aust. N. Z. J. Psychiatry, 38, 659–670, 2004.
Bulik C.M., Sullivan P.F., Fear J.L., Joyce P.R.: Eating disorders and antecedent anxiety disorders: a controlled study. Acta Psychiatr. Scand., 96, 101–107, 1997.
Urwin R.E., Nunn K.P.: Epistatic interaction between the monoamine oxidate A and serotonin transported genes in anorexia nervosa. Eur. J. Hum. Genet., 13, 370–375, 2005.
Yager J., Devlin M.J., Halmi K.A., Herzog D.B., Mitchell J.E., Powers P., Zerbe K.: Practice guideline for the treatment of patients with eating disorders — Third edition. Arlington, VA, American Psychiatric Association, 2006.
NICE. Eating disorders — core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, NICE Clinical Guideline no. 9, NICE, London, 2004.
The Anorexia Nervosa Care Pathway for Clinicians. CANCP Clin Versions 1.1 25.01.05, Anitt, 2005. Retrieved from: http://www.anitt.org.uk/downloads/ cpclinicians.pdf
Beumont P.J., Russell J.D., Touyz S.W.: Treatment of anorexia nervosa. Lancet, 341, 1635–1640, 1993.
Mitchell J.E, Crow S.: Medical complications of anorexia nervosa and bulimia nervosa. Curr. Opin. Psychiatry, 19, 438–443, 2006.
Katzman D.K.: Medical complications in adolescents with anorexia nervosa: a review of the literature. Int. J. Eat. Disord., 37 (Suppl), S52–S59, 2005.
Golden N.H., Katzman D.K., Kreipe R.E., Stevens S.L., Sawyer S.M., Rees J., Nicholls D., Rome E.S.: Society For Adolescent Medicine: Eating disorders in adolescent: position paper of the Society For Adolescent Medicine. J. Adolesc. Health, 33, 496–503, 2003.
Katzman D.K., Christensen B., Young A.R., Zipursky R.B.: Starving the brain: structural abnormalities and cognitive impairment in adolescents with anorexia nervosa. Semin. Clin. Neuropsychiatry, 6, 146–152, 2001.
Halmi K.A., Sunday S.R., Klump K.L., Strober M., Leckman J.F., Fichter M., Kaplan A., Woodside B., Treasure J., Berrettini W.H., Al Shabboat M., Bulik C.M., Kaye W.H.: Obsessions and compulsions in anorexia nervosa subtypes. Int. J. Eat. Disord., 33, 308–319, 2003.
Godart N.T., Flament M.F., Curt F., Perdereau F., Lang F., Venisse J.L., Halfon O., Bizouard P., Loas G., Corcos M., Jeammet P., Fermanian J.: Anxiety disorders in subjects seeking treatment for eating disorders: a DSM-IV controlled study. Psychiatry Res., 117, 245–258, 2003.
American Dietetic Association. Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders. J. Am. Diet. Assoc., 106, 2073–2082, 2006.
Zipfel S., Reas D.L., Thornton C., Olmsted M.P., Williamson D.A., Gerlinghoff M., Herzog W., Beumont P.J.: Day hospitalization programs for eating disorders: a systematic review of the literature. Int. J. Eat. Disord., 31, 105–117, 2002.
Robergeau K., Joseph J., Silber T.J.: Hospitalization of children and adolescents for eating disorders in the State of New York. J. Adolesc. Health, 39, 806–810, 2006.
Brown J.M., Mehler P.S., Harris R.H.: Medical complications occurring in adolescent with anorexia nervosa. West J. Med., 172, 189–193, 2000.
Diagnostic and statistical manual of mental disorders, 4th ed.: DSM-IV-TR. Washington, D.C., American Psychiatric Association, 2000.
Gentile M.G., Corradi E., Manna G.M., Ciceri R.: Enteral nutrition in severely ill patients with anorexia nervosa. Clin. Nutr., 19, 44–45, 2000, Supplement 1.
Paccagnella A., Mauri A., Baruffi C., Berto R., Zago R., Marcon M.L., Pizzolato D., Fontana F., Rizzo L., Bisetto M., Agostini S., Foscolo G.: Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a “lifesaving” treatment. JPEN J. Parenter. Enteral Nutr., 30, 231–239, 2006.
Garner D.M., Garfinkel P.E.: Handbook of Treatment for Eating Disorders, 2nd Ed. New York, Guildford, 1997.
Robin A.L., Siegel P.T., Moye A.W., Gilroy M., Dennis A.B., Sikand A.: A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J. Am. Acad. Child. Adolesc. Psychiatry, 38, 1482–1489, 1999.
Pike K.M., Walsh B.T., Vitousek K., Wilson G.T., Bauer J.: Cognitive behavior in the post hospitalization treatment of anorexia nervosa. Am. J. Psychiatry, 160, 2046–2049, 2003.
Gentile M.G.: L’intervento cognitivo-comportamentale integrato con quello nutrizionale nell’anoressia e nella bulimia nervosa [Integrated cognitive-behavioural and nutritional treatment in nervous anorexia and bulimia]. In: Gentile M.G.: Aggiornamenti in Nutrizione Clinica [Advances in Clinical Nutrition]. Roma, Il Pensiero Scientifico Ed., 21–42, 2001.
van Elburg A.A, Eijkemans M.J.C., Kas M.J.H., Themmen A.P.N., de Jong F.H., van Engeland H., Fauser B.C.J.M.: Predictors of recovery of ovarian function during weight gain in anorexia nervosa. Fertil. Steril., 87, 902–908, 2007.
Dominguez J., Goodman L., Sen Gupta S., Mayer L., Etu S.F., Walsh B.T., Wang J., Pierson R., Warren M.P.: Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses. Am. J. Clin. Nutrit., 86, 92–99, 2007.
Fichter M.M., Quadflieg N., Hedlund S.: Twelve-year course and outcome predictors of anorexia nervosa. Int. J. Eat. Disord., 39, 87–100, 2006.
Zandian M., Ioakimidis I., Bergh C., Södersten P.: Cause and treatment of anorexia nervosa. Physiol. Behav., 92, 283–290, 2007.
Dare C., Eisler I., Russell G., Treasure J., Dodge L.: Psychological therapies for adults with anorexia nervosa: randomised controlled trial of out-patient treatments. Br. J. Psychiatry, 178, 216–221, 2001.
Berkman N.D., Lohr K.N., Bulik C.M.: Outcomes of eating disorders: a systematic review of the literature. Int. J. Eat. Disord., 40, 293–309, 2007.
Masson P.C., Perlman C.M., Ross S.A., Gates A.L.: Premature termination of treatment in an inpatient eating disorder programme. Eur. Eat. Disord. Rev., 15, 275–282, 2007.
Bulik C.M., Berkman N.D., Brownley K.A., Sedway J.A., Lohr K.N.: Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int. J. Eat. Disord., 40, 310–320, 2007.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gentile, M.G., Manna, G.M., Ciceri, R. et al. Efficacy of inpatient treatment in severely malnourished anorexia nervosa patients. Eat Weight Disord 13, 191–197 (2008). https://doi.org/10.1007/BF03327506
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03327506