Löwe B, Zipfel S, Buchholz C, Dupont Y, Reas D L, Herzog W
Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Germany.
Psychol Med. 2001 Jul;31(5):881-90. doi: 10.1017/s003329170100407x.
Given our poor understanding of the very long-term course of anorexia nervosa. many questions remain regarding the potential for recovery and relapse. The purpose of the present study was to investigate long-term outcome and prognosis in an anorexic sample 21 years after the initial treatment.
A multidimensional and prospective design was used to assess outcome in 84 patients 9 years after a previous follow-up and 21 years after admission. Among the 70 living patients, the follow-up rate was 90%. Causes of death for the deceased patients were obtained through the attending physician. Predictors of a poor outcome at the 21-year follow-up were selected based on the results of a previous 12-year follow-up of these patients.
Fifty-one per cent of the patients were found to be fully recovered at follow-up, 21% were partially recovered and 10% still met full diagnostic criteria for anorexia nervosa. Sixteen per cent were deceased, due to causes related to anorexia nervosa. The standardized mortality rate was 9.8. The three groups also showed significant differences in psychosocial outcome. A low body mass index and a greater severity of social and psychological problems were identified as predictors of a poor outcome.
Recovery is still possible for anorexic patients after a period of 21 years. On the other hand, patients can relapse, becoming symptomatic again despite previously achieving recovery status. Only a few patients classified as having a poor outcome were found to seek any form of treatment, therefore, it is recommended that these patients should be monitored regularly and offered treatment whenever possible.
鉴于我们对神经性厌食症的长期病程了解不足，关于康复和复发的可能性仍存在许多问题。本研究的目的是调查初始治疗21年后一组厌食症患者的长期结局和预后。
采用多维度前瞻性设计，对84例患者在先前随访9年后及入院21年后的结局进行评估。在70例在世患者中，随访率为90%。通过主治医生获取已故患者的死亡原因。根据这些患者先前12年随访的结果，选择21年随访时预后不良的预测因素。
随访发现51%的患者完全康复，21%的患者部分康复，10%的患者仍符合神经性厌食症的全部诊断标准。16%的患者已死亡，死因与神经性厌食症有关。标准化死亡率为9.8。三组在心理社会结局方面也存在显著差异。低体重指数以及更严重的社会和心理问题被确定为预后不良的预测因素。
神经性厌食症患者在21年后仍有可能康复。另一方面，患者可能复发，尽管之前已达到康复状态，但再次出现症状。只有少数被归类为预后不良的患者寻求了任何形式的治疗，因此，建议对这些患者进行定期监测，并尽可能提供治疗。
