背景:神经性厌食症(AN)是一种严重的精神疾病,从中的复苏往往是旷日持久的。需要先前的专门住院治疗对慢性AN成人的后续治疗尝试的作用以及严重和持久AN(SE-AN)的治疗反应的预测因子,以改善预后。
方法:在入院特征(BMI,疾病的长度,门诊ED治疗史,症状学(ED,焦虑,和抑郁),自杀未遂或非自杀性自伤史(NSSI)),治疗动机和康复自我效能感,和出院结果(出院BMI,增重率,逗留时间,临床改善)。
结果:组的年龄相似,年病,入院BMI。+PH组所需体重较低,一生的最低点BMI和规范饮食的自我效能感,状态和特质焦虑高于-PH组。+PH也更有可能支持NSSI和自杀未遂的病史。关于出院结果,大多数患者在计划出院时实现体重恢复(平均出院BMI=19.8kg/m2).各组的体重增加率没有差异,去部分医院的可能性,部分住院时间,程序出院BMI,或临床改善的可能性(p's>0.05),尽管+PH组住院时间较长。
结论:与AN-PH相比,患有慢性AN+PH的参与者表现出更严重的精神病合并症和更低的规范饮食自我效能,然而,短期出院结局相似.未来的研究应确定体重恢复和针对合并症是否会影响慢性和重度PH患者的复发风险或需要再次住院。尽管疾病持续时间相似,那些患有慢性AN-PH的人可能能够更早地过渡到部分医院。相反,鉴于最近的转变促进了SE-AN成年人的自我指导入院,因此存在治疗不足的风险。比较患有慢性AN的+PH和-PH成年人的研究可能有助于努力个性化护理并表征强化治疗后的复发风险。
一些长期患有神经性厌食症(AN)的人尽管多次尝试强化治疗,但仍然生病。其他人仅在患病后期才首次达到高水平的专业护理(例如住院或住院)。这项研究比较了100例先前接受过特殊住院饮食失调护理的慢性AN(病情≥7年)住院患者与35例先前未接受强化治疗的慢性AN住院患者。参与者在入院时完成问卷,体重变化和住院过程在计划出院时通过图表审查进行评估。入院时,先前住院的个体报告焦虑和自杀行为有更大的困难,对改变饮食习惯的信心降低,和较低的期望体重相比,那些没有先前的住院治疗。两组在治疗期间的体重变化和临床改善相似,平均出院BMI与体重恢复一致。这些结果表明,无论他们以前是否接受过住院治疗,慢性AN患者的短期改善和体重恢复都是等效的,并且质疑最近对慢性和严重AN患者的短暂入院是否可能导致某些治疗不足,考虑到体重恢复仍然是长期恢复的最强预测因子。
BACKGROUND: Anorexia nervosa (AN) is a severe psychiatric disorder, from which recovery is often protracted. The role of prior specialized
inpatient treatment on subsequent treatment attempts for adults with chronic AN and predictors of treatment response for severe and enduring AN (SE-AN) are needed to improve outcomes.
METHODS: Participants (N = 135) with chronic AN (ill ≥7 years) admitted to an integrated
inpatient-partial hospitalization eating disorders (ED) unit with prior ED hospitalization(s) (+ PH; n = 100) were compared to those without prior ED hospitalizations (-PH; n = 35) on admission characteristics (BMI, length of illness, outpatient ED treatment history, symptomatology (ED, anxiety, and depressive), history of suicide attempts or non-suicidal self-injury (NSSI)), treatment motivation and recovery self-efficacy, and discharge outcomes (discharge BMI, rate of weight gain, length of stay, clinical improvement).
RESULTS: Groups were similar with regard to age, years ill, and admission BMI. The + PH group had lower desired weight, lifetime nadir BMI and self-efficacy for normative eating, and higher state and trait anxiety than the -PH group. +PH were also more likely to endorse history of NSSI and suicide attempt. Regarding discharge outcomes, most patients achieved weight restoration at program discharge (mean discharge BMI = 19.8 kg/m2). Groups did not differ on rate of weight gain, likelihood of attending partial hospital, partial hospital length of stay, program discharge BMI, or likelihood of clinical improvement (p\'s > 0.05) although
inpatient length of stay was longer for the + PH group.
CONCLUSIONS: Participants with chronic AN + PH exhibited more severe psychiatric comorbidity and lower self-efficacy for normative eating than AN -PH, however short-term discharge outcomes were similar. Future research should determine whether weight restoration and targeting comorbidities impacts relapse risk or need for rehospitalization among chronic and severe + PH. Despite similar illness durations, those with chronic AN -PH may be able to transition to partial hospital earlier. Conversely there is risk of undertreatment of chronic AN + PH given the recent shift promoting briefer self-directed admissions for adults with SE-AN. Research comparing + PH and -PH adults with chronic AN may facilitate efforts to individualize care and characterize relapse risk following intensive treatment.
Some individuals with longstanding anorexia nervosa (AN) remain ill despite multiple attempts at intensive treatment. Others reach a high level of specialty care (e.g.
inpatient or residential) for the first time only late in their illness. This study compared 100 hospitalized patients with chronic AN (ill ≥ 7 years) who previously received specialty
inpatient eating disorder care to 35 hospitalized patients with chronic AN and no prior intensive treatment. Participants completed questionnaires at admission and weight change and hospital course were assessed at program discharge by chart review. At admission, individuals with prior hospitalizations reported greater difficulties with anxiety and suicidal behavior, lower confidence for changing their eating habits, and lower desired body weight compared to those with no prior inpatient treatment. Both groups had similar weight change and clinical improvement during treatment with mean discharge BMI consistent with weight restoration. These outcomes suggest equivalent short term improvement and weight restoration for individuals with chronic AN regardless of whether they previously received inpatient treatment and call into question whether the recent shift to brief admissions for those with chronic and severe AN may result for some in undertreatment, given that weight restoration remains the strongest predictor of long-term recovery.