Systematic review of evidence for different treatment settings in anorexia nervosa

Abstract

AIM:To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS:Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms "anorexia nervosa" and "treatment" dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS:Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION:There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa. Core tip: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. This study compared outcomes in AN treatment studies comparing different treatment settings: inpatient, day-patient and outpatient. Five studies were identified. There was no difference in outcomes between the different settings and lengths of inpatient treatment. Both outpatient and day-patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was cheaper than prolonged inpatient care for weight normalization. There is support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting.

Treatment of eating disorders in child and adolescent psychiatry

“…A systematic review by Madden [12] evaluated five studies, including three studies with adolescents.…”

Follow‐up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study

“…Previous research in the field of anorexia nervosa (AN) has highlighted a lack of evidence-based treatment approaches, and to date, there is limited empirical evidence for psychological interventions in adult AN (Bulik, Berkman, Brownley, Sedway, & Lohr, 2007;Espie & Eisler, 2015;Herpertz-Dahlmann, van Elburg, Castro-Fornieles, & Schmidt, 2015;Madden, Hay, & Touyz, 2015). For children and adolescents, family therapy has been shown as an effective treatment (Espie & Eisler, 2015;Hoek, 2015).…”

Steps of care for adolescents with anorexia nervosa—A Delphi study

“…The challenge in finding consensus for this important question underscores the need for more longitudinal outcome data. There is some evidence to suggest that transitioning adolescents to outpatient FBT as soon as possible after medical stabilization is cost effective (Madden, Hay, & Touyz, ) and important for long‐term success (Hay et al, ). There are also some data that might influence treatment decisions that did not come up in this panel discussion.…”