Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
South London and Maudsley NHS Foundation Trust, Adult Inpatient Eating Disorders Service, Tyson West 2, Bethlem Royal Hospital, Beckenham, UK.
Eur Eat Disord Rev. 2021 May;29(3):306-315. doi: 10.1002/erv.2821. Epub 2021 Feb 24.
The aim of this paper is to consider how changes in service planning and delivery might improve the care pathways for adult anorexia nervosa. Although anorexia nervosa has a long history in Europe, its framing as a mental disorder is quite recent. The changing forms and increasing epidemiology of eating disorders has led to the expansion of specialised services. Although some services provide care over the entire clinical course, more often services are divided into those that care for children and adolescents or adults. The transition needs to be carefully managed as currently these services may have a different ethos and expectations. Services for adults have a broad range of diversity (diagnostic subtype, medical severity, comorbidity, stage of illness and psychosocial functioning) all of which impacts on prognosis. A tailored, approach to treatment planning could optimise the pathway. Facilitating early help seeking and rapid diagnosis in primary care and reducing specialised services waiting lists for assessment and treatment could be a form of secondary prevention. The use of precision models and /or continuous outcome monitoring might reduce the third of patients who require more intensive care by applying augmentation strategies. Finally, gains from intensive care might be sustained by relapse prevention interventions and community support to bridge the transition home. Together these measures might reduce the proportion of patients (currently a third) with ill health for over 20 years. For this group rehabilitation strategies may improve functioning until new treatment emerge.
本文旨在探讨服务计划和提供方式的变化如何改善成年厌食症患者的治疗途径。尽管厌食症在欧洲有着悠久的历史，但将其归类为精神障碍是最近才出现的。饮食失调症的形式和流行率不断变化，导致专门服务的扩大。尽管有些服务提供整个临床过程的护理，但更多的服务是为儿童和青少年或成年人提供的。由于目前这些服务可能具有不同的理念和期望，因此需要谨慎管理过渡。为成年人提供的服务具有广泛的多样性（诊断亚型、医疗严重程度、共病、疾病阶段和心理社会功能），所有这些都对预后产生影响。量身定制的治疗计划方法可以优化治疗途径。在初级保健中促进早期寻求帮助和快速诊断，并减少专门服务的评估和治疗等候名单，这可能是一种二级预防形式。使用精确模型和/或连续结果监测可能通过应用增强策略减少三分之一需要更密集护理的患者。最后，通过预防复发干预措施和社区支持来维持强化护理的收益，以帮助患者过渡回家，这些措施可能会减少三分之一（目前为三分之一）患者出现 20 年以上健康状况不佳的情况。对于这群患者，康复策略可以改善他们的功能，直到新的治疗方法出现。
