Predictive factors of dropout from inpatient treatment for anorexia nervosa (original) (raw)
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Predictors of dropout from inpatient treatment for anorexia nervosa: Data from a large French sample
Psychiatry Research, 2011
Dropout from anorexia nervosa inpatient treatment program is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).
Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa
Psychiatry Research, 2013
We examined factors predictive of dropout from inpatient treatment for anorexia nervosa (AN) among adolescents in a prospective study of 359 consecutive hospitalizations for AN (DSM-IV). Patients were assessed at admission (clinical, socio-demographic, and psychological data). Multivariate analyses were performed. Drop-out (i.e. leaving hospital before the target weight is achieved) occurred in 24% (n ¼86) of hospitalizations; in 42.3% (n ¼30) of the cases, dropout was initiated by the treatment team and in 58.6% (n ¼41) by the patients and/or their parents. 18.6% (16/86) occurred during the first half of the inpatient program. Frequency of drop-out was significantly higher when the patient was living with only one parent, had been hospitalized previously, had a lower BMI at admission and was over 18 at admission. These elements should draw the attention of the clinician, so that he/she can prepare hospitalization with patients presenting lower admission BMI, particularly by motivational interventions for a better therapeutic alliance, and by the deployment of intensive accompaniment of single parents. Further studies aiming to replicate these results, and including the evaluation of other clinical dimensions such as impulsivity and other personality traits, are needed to elucidate this important topic.
Inpatient treatment and anorexia nervosa outcomes
e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism, 2010
Background & aims: Outcomes of anorexia nervosa in patients meeting criteria for hospitalization were compared to those treated as outpatients. Methods: A questionnaire on the quality of recovery was completed by 143 patients. Groups were defined according to indication for hospitalization during the first 6 months of care (inpatient treatment: n ¼ 46, ambulatory treatment: n ¼ 97). Results: At intake, inpatients were characterized by lower BMI, and by higher prevalence of restrictive forms of the disease and prior suicide attempts. After 5 year follow-up, outcomes were similar in inpatients and outpatients respectively for BMI (18.4 vs. 19.2 kg/m 2), frequency of BMI normalization (45.7 vs. 49%), self reports of feeling ''completely cured'' (21% in both), educational attainment and professional functioning. Amenorrhea was more frequent in inpatients (21.7% vs. 8.2%). Inpatients also more frequently continued under medical supervision at the time of this study. Conclusions: Despite a more severe initial presentation, patients requiring hospitalization at entry exhibited outcomes comparable to outpatients, although requiring longer care.
The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization
BioPsychoSocial Medicine, 2014
Background: This study was done to determine which psychosocial factors are related to the urgent hospitalization of anorexia nervosa patients (AN) due to extremely poor physical condition and to evaluate their outcome after inpatient treatment. Methods: 133 hospitalized AN patients were classified into an urgent hospitalization (n = 24) or a planned hospitalization (n = 109) group. Multiple regression analysis was done of clinical features, body mass index (BMI), psychological tests [The Minnesota Multiphasic Personality Inventory (MMPI), alexithymia, relationship with parents, and the Eating Disorder Inventory (EDI)]. The effectiveness of treatment was prospectively determined two years after discharge by the Global Clinical Score (GCS). The hospitalized weight gain and the frequency of outpatient visits were evaluated. Results: Of the factors assessed, only BMI at admission was related to the necessity of urgent hospitalization (β = − 1.063, P = 0.00). The urgent group had significantly more weight loss after discharge and poorer social adaptation on the GCS, even when the patient had a sufficient increase in body weight during inpatient treatment and an equivalent number of outpatient consultations. Conclusion: None of the parameters of the psychosocial tests studied were significantly different between the groups. The outcome of the urgent group was poor. Two years after discharge they had difficulty maintaining weight and continued to have poor social adaptation.
Journal of Eating Disorders
Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by i...
Predictive factors of length of inpatient treatment in anorexia nervosa
2008
ObjectiveTo identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN).MethodWe analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS.ResultsMean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder.ConclusionsThe identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance.
Eating and weight disorders : EWD, 2000
To evaluate the effectiveness of an integrated medical-psychiatric treatment of major eating disorders. Historical cohort study. Outpatient Unit for Protein Energy Malnutrition of the Department of Clinical and Experimental Medicine, "Federico II" University of Naples, time of study: January 1994 to December 1997 PARTICIPANTS: 147 female patients with restrictive or bulimic anorexia nervosa (mean age 19.8 +/- 13.7, BMI 14.7 +/- 2.1 Kg/m2) consecutively attending the outpatient unit between January 1994 and December 1997. Hospitalization and mortality rates were evaluated up to Jan 1999 with a minimum follow-up of 18 months. There were 23 admissions to the Clinical Nutrition ward for 19 patients (i.e. 12.9%) mostly due to severe protein energy malnutrition, and 2 deaths, only 1 strictly related to anorexia (mortality rate 0.7%). Integrated outpatient medical-psychiatric treatment for major eating disorders is an effective and inexpensive procedure that reduces mortality and...