Improvements on Clinical Status of Adolescents With Anorexia Nervosa in Inpatient and Day Hospital Treatment: A Retrospective Pilot Study

Abstract

Introduction: Medical and psychiatric complications and treatment compliance are important considerations in determining the treatment program for patients with severe anorexia nervosa (AN). Clinical practice guidelines agree that an outpatient program is the first choice for the treatment of most eating disorders, but vary in supporting these programs for AN. However, inpatient care is known to be costly and the risk of relapse and readmission is high. This pilot study aimed to describe the first data on an Italian partial hospitalization care program for AN adolescents [high-level care treatment (HLCT)], evaluating its impact on patients' clinical status, average hospitalization time, and the hospital costs compared to inpatient treatment (IP).Methods: For this retrospective pilot study, we have selected a group of 34 females with AN aged 11–18 years, divided between those who followed inpatient treatment and those who received HLCT treatment; they were matched for age and severity. We investigated the differences in treatment and outcomes between the two groups in terms of heart rate, length of treatment, weight gain, psychological characteristics, and hospital costs. Statistics for non-parametric distributions were used to compare the two groups.Results: No differences between the two groups were found at admission. At discharge, patients in the HLCT group presented a lower number of in-hospital treatment days, a higher increase of weight, and a significant improvement in outcomes compared to the inpatient group. No significant differences were found in heart rate and hospital costs.Conclusions: This study represents a first comparison between inpatient care and the HLCT treatment program, which suggests that day hospital treatment could represent a meeting point between inpatient and outpatient treatment, combining the merits of both forms of treatment. Further studies are needed in order to better investigate the different treatment programs for severe AN in adolescence.

Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

“…Despite difficulties in managing patients’ ED behaviours outside of treatment and the necessity of patient motivation, DP treatment appears to permit greater links to one’s home environment, greater responsibility in recovery, and a smoother transition out of intensive treatment. These findings provide support for DP treatment as an alternative to IP treatment for individuals with severe AN [ 10 , 26 ] and calls for the introduction of more evidence-based intensive DP treatment programs to meet the needs of all patients with AN [ 27 ]. Further research comparing the two intensive treatment approaches is necessary, as while both settings are valued, it remains unknown which treatments work best for whom at what time.…”

Day Programs for children and adolescents with eating disorders: A systematic review

“…Of the six studies that utilized the CDI, four reported significant reductions in depressive symptoms at discharge (Girz et al, 2013;Henderson et al, 2014;Ornstein et al, 2012;Rienecke & Richmond, 2018). Similarly, the improvements in anxiety and general functioning were observed in studies utilizing the MRAOS, RCMAS and MASC at discharge (Henderson et al, 2014;Ornstein et al, 2012;Zanna et al, 2021). Regarding follow-up data, Girz et al (2013) found significant reductions in depressive and anxiety symptoms at three-and six-month follow-up utilizing the CDI and MASC respectively.…”

“…Four studies did not conduct inferential statistical analyses to assess changes in weight (Girz et al, 2013;Grewal et al, 2014;Lazaro et al, 2011;Ngo & Isserlin, 2014), with several studies not reporting on effect sizes. Of the studies that reported effect sizes related to changes in body weight post-treatment, two studies reported small effect (d = 0.30 to 0.50; Goldstein et al, 2011; r = 0.10 to 0.30; Bryson et al, 2018) and two studies reported medium to large effect sizes (d = 0.50 and higher; Simic et al, 2018;r = 0.30 and higher;Bryson et al, 2018;Zanna et al, 2021). Goldstein et al (2011) reported medium to large effect sizes in six-month followup (d = 0.86).…”

“…Six studies reported that patients maintained their weight gain at 3, 6, 12 or 31 months post discharge. Only Zanna et al (2021) discussed using the measurement of any other metabolic monitoring indicator (heart rate).…”

Early Naso-Gastric Feeding and Outcomes of Anorexia Nervosa Patients

“…), in agreement with previous reports [ 26 ]. Recent research comparing inpatient treatment with outpatient treatment has described the advantages of this outpatient management approach; the rapid return to normal social activities and family environment favours a better treatment process, both for weight restoration and psychological recovery [ 27 , 28 ].…”