Born Christoph, de la Fontaine Larissa, Winter Bettina, Müller Norbert, Schaub Annette, Früstück Clemens, Schüle Cornelius, Voderholzer Ulrich, Cuntz Ulrich, Falkai Peter, Meisenzahl Eva
Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany.
Schoen-Klinik Roseneck, Prien am Chiemsee, Germany.
BMC Psychiatry. 2015 Mar 24;15:57. doi: 10.1186/s12888-015-0436-7.
Anorexia nervosa (AN) is associated with a high mortality rate. This study describes a compulsory re-feeding program established in Munich for extremely underweight patients.
The contract between the patient and the therapeutic team included mandatory inpatient status, establishment of guardianship and compulsory re-feeding with a percutaneous gastric feeding tube, as indicated. The predefined target was a body mass index (BMI) of 17 kg/m(2). Data on the first 68 patients with AN are presented.
65 (95.6%) patients were female and mean age at admission was 26.5 ± 8.5 years. BMI increased from 12.3 ± 1.4 kg/m(2) at admission to 16.7 ± 1.7 kg/m(2) at discharge. Thirty-two (47.1%) patients had the restrictive subtype (ANR) and 36 (52.9%) had the binging and purging subtype (ANBP). Duration of illness before admission (p = .004), days of treatment until discharge (p = .001) and weight increase (p = .02) were significantly different between subgroups in favor of patients with ANR. Also, seasonal differences could be found. Comparison of feeding methods showed that percutaneous tube feeding was superior. Almost half of the patients were treated with psychotropic medication. To date, however, the number of patients included in this program is too small to assess rare complications of this acute treatment program and long term outcomes of AN.
An intensive care program for severely ill AN patients has been successfully established. Besides averting physical harm in the short term, this program was designed to enable these patients to participate in more sophisticated psychotherapeutic programs afterwards. To our knowledge, this is the first such program that regularly uses percutaneous feeding tubes.
神经性厌食症（AN）与高死亡率相关。本研究描述了在慕尼黑为极度体重过轻的患者建立的强制重新进食计划。
患者与治疗团队之间的合同包括强制住院状态、设立监护以及根据需要通过经皮胃饲管进行强制重新进食。预定义目标是体重指数（BMI）达到17kg/m²。本文呈现了首批68例AN患者的数据。
65例（95.6%）患者为女性，入院时的平均年龄为26.5±8.5岁。BMI从入院时的12.3±1.4kg/m²增至出院时的16.7±1.7kg/m²。32例（47.1%）患者为限制型亚型（ANR），36例（52.9%）为暴食清除型亚型（ANBP）。入院前的病程（p = 0.004）、直至出院的治疗天数（p = 0.001）以及体重增加情况（p = 0.02）在各亚组之间存在显著差异，有利于ANR患者。此外，还发现了季节差异。喂养方法的比较表明经皮管饲更具优势。几乎一半的患者接受了精神药物治疗。然而，迄今为止，纳入该计划的患者数量过少，无法评估这一急性治疗计划的罕见并发症以及AN的长期结局。
已成功建立了针对重症AN患者的重症监护计划。除了在短期内避免身体伤害外，该计划旨在使这些患者随后能够参与更复杂的心理治疗计划。据我们所知，这是首个常规使用经皮饲管的此类计划。
