Eating Disorders Centre, Neurosciences Department, University of Turin, Turin, Italy.
Eat Weight Disord. 2009 Jun-Sep;14(2-3):e31-41. doi: 10.1007/BF03327798.
Day hospital (DH) treatments for eating disorders (EDs) provide intensive daily care and allow patients to maintain and test their social relations and coping skills at home and outside. Although widespread, their description is lacking. This review compares the different types of DH described in the literature and presents our DH experience in Turin, Italy. We searched Psychinfo and Pubmed with the following keywords: anorexia nervosa, bulimia nervosa, EDs, DH, day treatment and partial hospitalisation. We found and reviewed the DH programmes of eleven specialised centres, which have some shared features but also many differences, suggesting that DH treatments are still largely experimental. Briefly, the shared elements are: biopsychosocial model as reference frame; cognitive-behavioural model or techniques; behavioural contract; patients' selection; body image therapy; involvement of family; weight normalisation/weight gain and modification/normalisation of eating behaviour as objectives. Nonetheless, shared opinions concerning inclusion criteria are lacking; the duration of DH treatment is surprisingly different among centres (from 3 to 39 weeks); the approach to eating and compensation behaviours ranges from control to autonomy; followup and psychometric assessment can be either performed or not; psychological and behavioural objectives can be different. This review suggests the existence of two different DH models: the first has a shorter duration and is mainly symptom-focused; the second is more individual-focused, has a longer duration and is focused on patients' relational skills, psychodynamic understanding of symptoms and more gradual changes in body weight. Further investigation is required to make DH treatment programmes measurable and comparable.
日间医院（DH）治疗饮食失调症（ED）提供密集的日常护理，使患者能够在家中和外部维持和测试他们的社会关系和应对技能。尽管这种治疗方法已经广泛应用，但对其描述却缺乏一致性。本综述比较了文献中描述的不同类型的 DH，并介绍了我们在意大利都灵的 DH 经验。我们在 Psychinfo 和 Pubmed 上使用了以下关键词进行搜索：神经性厌食症、神经性贪食症、ED、DH、日间治疗和部分住院治疗。我们找到了并回顾了十一个专门中心的 DH 计划，这些计划具有一些共同的特点，但也有许多差异，这表明 DH 治疗仍然在很大程度上是实验性的。简要地说，共同的要素包括：生物心理社会模型作为参考框架；认知行为模型或技术；行为契约；患者选择；身体意象治疗；家庭参与；体重正常化/体重增加和饮食行为的改变/正常化作为目标。然而，对于纳入标准缺乏共同的意见；DH 治疗的持续时间在各个中心之间差异很大（从 3 周到 39 周）；对进食和补偿行为的处理方法从控制到自主不等；随访和心理测量评估可以进行也可以不进行；心理和行为目标可能不同。本综述表明存在两种不同的 DH 模式：第一种模式持续时间较短，主要以症状为重点；第二种模式更注重个体，持续时间较长，侧重于患者的社交技能、对症状的心理动力学理解以及体重的逐渐变化。需要进一步的研究来使 DH 治疗计划具有可衡量性和可比性。
