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Shortened Hospitalization for Anorexia Nervosa May Work

February 12, 2014

Shortened Hospitalization for Anorexia Nervosa May Work

  1. Joel Yager, MD

Brief inpatient stabilization followed by day treatment was noninferior to, and less expensive than, longer-term inpatient care.

  1. Joel Yager, MD

Clinicians who treat patients with anorexia nervosa debate the benefits of long-term hospitalizations versus less costly interventions. To study the effectiveness of brief inpatient stabilization followed by day treatment for anorexia nervosa patients, investigators in Germany conducted a multicenter, randomized, controlled, noninferiority trial involving 172 adolescent females who were hospitalized for the first time with the disorder (mean age, 15; body-mass index [BMI], 15; mean age-adjusted BMI percentile, 2).

After 3 weeks of inpatient stabilization, participants were randomized to hospital-based day treatment or continued inpatient care. Overall, 18% of patients had the binge-purge subtype; psychiatric comorbidities were similar in the two groups. Inpatient treatment included nutrition counseling, cognitive-behavioral therapy, and family therapy. Patients were discharged from care after maintaining weight for 2 weeks between the 15th and 20th percentiles for BMI. Few patients dropped out.

Brief inpatient stabilization plus day treatment was noninferior to continued inpatient care in terms of weight gain and maintenance from admission through the 12-month follow-up. It lasted longer (mean, 16.5 vs. 14.6 weeks) but was significantly less expensive (US$40,687 vs. US$51,629). Serious adverse events (roughly 10%) and readmissions were similar in both groups.

Comment

In moderately-to-severely ill, young patients with relatively new-onset disease, day treatment after brief inpatient stabilization was comparable to longer hospitalizations and may have helped mental well-being and social adjustment. Unfortunately, as an editorialist notes, even with treatment, BMIs were still under the 10th percentile in 59% of patients. Better assessment of these findings depends on learning how these gains can be sustained in longer follow-ups; how the groups differed in family support, the impact of illness on families, and medication use; and how the studied treatments would compare with family-based treatments.

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Research; Eating Disorders Review (Editor-in-Chief); Harvard Review of Psychiatry; International Journal of Eating Disorders; UpToDate Leadership positions in professional societies American Psychiatric Association (Chair, Steering Committee and Executive Committee on Practice Guidelines; Co-Chair, DSM5 Clinical and Public Health Committee; Chair, Council on Research and Quality Care)

Citation(s):

Reader Comments (1)

Michael Nussbaum, M.D. Physician, Pediatrics/Adolescent Medicine, Holbrook, NY- private practice

In a past study of long term follow up of patients with anorxia nervosa we published in 1985 we had a success rate of approximately 85%.
Our patients were in patients for 30-60 days.
We now see that short term hospitalization often refers to 3-4 days and then transferred to out patient program. Your study had patients in for 3 weeks which is not as short term as many places are using now. I do believe that we need to see long term results. Ours were over 5 years and 85 % of the adolescent girls in our program had stable weights and were menstruating again. We must be cautious that though it is less costly to put patients in an out patient program is it in the best interests of our patients or the best interest of the insurance companies!

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