Skip to main content

Efficacy of inpatient treatment in severely malnourished anorexia nervosa patients

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity volume 13, pages 191–197 (2008)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Hoek H.W.: Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Curr. Opin. Psychiatry, 19, 389–394, 2006.

    PubMed  Article  Google Scholar 

  2. Treasure J., Schmidt U.: Anorexia nervosa. Clin. Evid., 11, 1192–1203, 2004.

    PubMed  Google Scholar 

  3. 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.

    PubMed  Article  CAS  Google Scholar 

  4. 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.

    PubMed  Article  Google Scholar 

  5. 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.

    PubMed  Article  CAS  Google Scholar 

  6. 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.

    PubMed  Article  CAS  Google Scholar 

  7. 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.

    Google Scholar 

  8. 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.

    Google Scholar 

  9. 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

  10. Beumont P.J., Russell J.D., Touyz S.W.: Treatment of anorexia nervosa. Lancet, 341, 1635–1640, 1993.

    PubMed  Article  CAS  Google Scholar 

  11. Mitchell J.E, Crow S.: Medical complications of anorexia nervosa and bulimia nervosa. Curr. Opin. Psychiatry, 19, 438–443, 2006.

    PubMed  Article  Google Scholar 

  12. Katzman D.K.: Medical complications in adolescents with anorexia nervosa: a review of the literature. Int. J. Eat. Disord., 37 (Suppl), S52–S59, 2005.

    PubMed  Article  Google Scholar 

  13. 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.

    PubMed  Google Scholar 

  14. 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.

    PubMed  Article  CAS  Google Scholar 

  15. 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.

    PubMed  Article  Google Scholar 

  16. 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.

    PubMed  Article  Google Scholar 

  17. 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.

    Google Scholar 

  18. 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.

    PubMed  Article  Google Scholar 

  19. 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.

    PubMed  Article  Google Scholar 

  20. Brown J.M., Mehler P.S., Harris R.H.: Medical complications occurring in adolescent with anorexia nervosa. West J. Med., 172, 189–193, 2000.

    PubMed  Article  CAS  Google Scholar 

  21. Diagnostic and statistical manual of mental disorders, 4th ed.: DSM-IV-TR. Washington, D.C., American Psychiatric Association, 2000.

  22. 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.

    Google Scholar 

  23. 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.

    PubMed  Article  Google Scholar 

  24. Garner D.M., Garfinkel P.E.: Handbook of Treatment for Eating Disorders, 2nd Ed. New York, Guildford, 1997.

    Google Scholar 

  25. 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.

    PubMed  Article  CAS  Google Scholar 

  26. 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.

    PubMed  Article  Google Scholar 

  27. 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.

    Google Scholar 

  28. 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.

    PubMed  Article  Google Scholar 

  29. 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.

    PubMed  CAS  Google Scholar 

  30. Fichter M.M., Quadflieg N., Hedlund S.: Twelve-year course and outcome predictors of anorexia nervosa. Int. J. Eat. Disord., 39, 87–100, 2006.

    PubMed  Article  Google Scholar 

  31. Zandian M., Ioakimidis I., Bergh C., Södersten P.: Cause and treatment of anorexia nervosa. Physiol. Behav., 92, 283–290, 2007.

    PubMed  Article  CAS  Google Scholar 

  32. 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.

    PubMed  Article  CAS  Google Scholar 

  33. 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.

    PubMed  Article  Google Scholar 

  34. 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.

    PubMed  Article  Google Scholar 

  35. 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.

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Director, Eating Disorders Unit, Dietetic and Clinical Nutrition Department, Niguarda Hospital, Piazza Maggiore 3, 20126, Milano, Italy

    M. G. Gentile, G. M. Manna, R. Ciceri & E. Rodeschini

Authors
  1. M. G. Gentile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. M. Manna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Ciceri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Rodeschini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. G. Gentile.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03327506

Key words

  • Anorexia nervosa
  • inpatient treatment
  • multidisciplinary team
  • nutritional rehabilitation