Day Hospital Treatment for Anorexia Nervosa: A 12‐Month Follow‐up Study

Abstract

Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence-based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty-six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12-month follow-up evaluation (T18) using Eating Disorders Inventory-2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy-eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long-standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow-up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted.

A Narrative Review of Outcome Studies for Residential and Partial Hospital‐based Treatment of Eating Disorders

“…Ten open PHP trials focused primarily on adults (Abbate‐Daga et al, ; Crino & Djokvucic, ; Exterkate et al, ; Fittig et al, ; Goddard et al, ; Jones et al, ; Olmsted et al, ; Olmsted et al, ; Willinge et al, ; Zeeck et al, ) (Table ). All of these studies reported significant improvements in BMI for patients with AN and/or reductions in binge and purge frequency for patients with BN; six of these studies reported medium to large effect sizes (Abbate‐Daga et al, ; Crino & Djokvucic, ; Exterkate et al, ; Fittig et al, ; Willinge et al, ; Zeeck et al, ). For psychological measures, several studies reported significant improvements in measures of depression and anxiety, in addition to the specific measures of ED pathology (Abbate‐Daga et al, ; Crino & Djokvucic, ; Exterkate et al, ; Fittig et al, ; Jones et al, ; Olmsted et al, ; Olmsted et al, ; Willinge et al, ).…”

“…All of these studies reported significant improvements in BMI for patients with AN and/or reductions in binge and purge frequency for patients with BN; six of these studies reported medium to large effect sizes (Abbate‐Daga et al, ; Crino & Djokvucic, ; Exterkate et al, ; Fittig et al, ; Willinge et al, ; Zeeck et al, ). For psychological measures, several studies reported significant improvements in measures of depression and anxiety, in addition to the specific measures of ED pathology (Abbate‐Daga et al, ; Crino & Djokvucic, ; Exterkate et al, ; Fittig et al, ; Jones et al, ; Olmsted et al, ; Olmsted et al, ; Willinge et al, ). Zeeck et al () provided additional support for PHP treatment for BN by matching a PHP sample to an extended inpatient sample; no significant differences between the two modalities in treating patients were reported, as measured by the Eating Disorder Inventory (EDI).…”

Estudos clínicos em psicoterapia psicodinâmica: uma revisão do follow-up das intervenções

“…Foram encontradas também intervenções com medicamentos como a fluoxetina (Sørensen et al, 2011), sozinhos ou combinados com psicoterapia psicodinâmica (Koppers et al, 2011); e também intervenções combinadas com outros tratamentos multidisciplinares, tais como dieta alimentar e acompanhamento familiar (Abba-te Daga et al, 2015).…”

“…Outro método utilizado para complementar os questionários foram entrevistas presenciais semiestruturadas desenvolvidas para o próprio estudo, ou entrevistas estruturadas, por exemplo: Operationalized Psychodynamic Diagnosis -OPD Task Force (Levi et al,2015;Vinnars et al, 2009;Marttunen et al, 2008;Johansson et al, 2013;Kronström et al, 2009;Koppers et al, 2011;Høglend et al, 2008;Gude e Hoffart, 2008;Abbate-Daga et al, 2015;Berghout e Zevalkink, 2009;Lilliengren et al, 2015;Grande et al, 2009;Arvidson et al, 2011;Leichsenring et al, 2014). O estudo que avaliou custo-efetividade dos serviços de saúde também utilizou, além dos questionários, os registros nacionais de verificação para compor as medidas de follow-up (Abass et al, 2015).…”

“…Novamente, ambos os grupos obtiveram resultados positivos de progresso terapêutico, sendo o grupo de PP superior em duas oportunidades, em relação à manutenção das medidas de melhora no follow-up comparada a medicação (Kronström et al, 2009) e a TAU (Sattel et al, 2012); e, sem diferenças significativas entre os grupos em um estudo, nos quais os dois grupos apresentaram recaí-da (Koppers et al, 2011). Houve também um estudo em que a PP foi combinada a outras intervenções multidisciplinares e também foi efetiva (Abbate-Daga et al, 2015).…”