Inpatient versus Day Clinic Treatment for Bulimia Nervosa: A Randomized Trial

Abstract

Background: In bulimia nervosa, more intense treatments are recommended if outpatient treatment fails. This is the first randomized controlled trial comparing the options of inpatient versus day clinic treatment. Method: Patients with severe bulimia nervosa were randomly assigned to inpatient or day clinic treatment of similar length and intensity. Specific and general psychopathology was assessed at the end of treatment and a 3-month follow-up. Results: Fifty-five patients were randomized; 22 day clinic patients and 21 inpatients started the program. At the end of treatment, a significant reduction of general and specific pathology was found in both settings. Following discharge, there was more deterioration in bulimic symptoms after inpatient treatment, but overall, results were comparable. Conclusions: Inpatient and day clinic programs are effective treatments for severely disturbed bulimic patients with similar results at the 3-month follow-up. Further follow-up will show if a higher instability of results after inpatient treatment is of importance in the long term.

Effectiveness of Different Modalities of Psychotherapeutic Treatment for Patients with Cluster C Personality Disorders: Results of a Large Prospective Multicentre Study

“…Furthermore, even if researchers were successful in setting up and starting a randomised treatment modality study, its external validity would be doubtful because a high number of patients would refuse to participate [e.g. [20]]. Therefore, quasi-experimental studies using statistical correction models to counter selection bias are increasingly being found in the literature [e.g.…”

Inpatient versus Day Treatment for Bulimia Nervosa: Results of a One-Year Follow-Up

“…Medication and outpatient treatment after discharge were controlled for. We report on complete (paired) data as well as intention-to-treat analyses (last value carried forward, in order to replace missing data), as relevant covariates like medication or maintenance treatment after discharge are only known if patients were seen at followup.The groups were neither significantly different when starting treatment nor on any outcome variable at discharge [10] . The small sample size prevents testing significance of equivalence, but the differences of means between groups could be considered to be clinically irrelevant.…”

“…The aim of this study was a comparison of day clinic and inpatient treatment for bulimia nervosa including a 3-and 12-month follow-up. We reported in detail on the design and 3-month outcome in a previous article [10] and present the results of the 12-month follow-up in this letter.Fifty-five of 204 patients screened at our outpatient clinic fulfilled the inclusion criteria [10] , gave informed consent and could be randomized. Twenty-one percent were lost before admission.…”

“…The treatments represent common multimodal inpatient and day clinic programs in Germany, integrating psychodynamic, cognitive-behavioral and systemic components. Medication (selective serotonin reuptake inhibitor) was given when needed [10] . Treatment length was about 12 weeks of inpatient or day clinic treatment, with some flexibility ( 8 1-3 weeks) [10] .…”

“…Medication (selective serotonin reuptake inhibitor) was given when needed [10] . Treatment length was about 12 weeks of inpatient or day clinic treatment, with some flexibility ( 8 1-3 weeks) [10] .Before treatment, at discharge as well as at 3-and 12-month follow-up, eating behavior and general psychopathology was assessed by the EDI-2 [11,12] , the expert rating form of the SIAB-EX [13] and the SCL-90-R [14,15] . Diagnoses were given according to SCID I+II [16] .…”