Frostad Stein, Bentz Mette
Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway.
Child and Adolescent Mental Health Centre, Capital Region of Denmark, University of Copenhagen, Copenhagen 2400, Denmark.
World J Psychiatry. 2022 Apr 19;12(4):558-579. doi: 10.5498/wjp.v12.i4.558.
Anorexia nervosa (AN) is a disabling, costly and potentially deadly illness. Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN. The time from AN debut to the treatment initiation is normally unreasonably long. Over the past 20 years there has been empirical support for the efficacy of several treatments for AN. Moreover, outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients. Early intervention improves outcomes and should be a priority for all patients. Outpatient treatment is usually the best format for early intervention, and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable. Inpatient care is more disruptive, more costly, and usually has a longer waiting list than does outpatient care. The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult. The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN. The scientific essentials for outpatient treatment are described, including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated. The following aspects are discussed: early intervention, outpatient treatment of AN, including outpatient psychotherapy for severe and extreme AN, how to determine when outpatient treatment is safe, and when transfer to inpatient healthcare is indicated. Emerging treatments, ethical issues and outstanding research questions are also addressed.
神经性厌食症（AN）是一种致残、代价高昂且可能致命的疾病。完成治疗后，治疗失败和复发很常见，而且相当一部分患者会发展为严重且持久的神经性厌食症。从神经性厌食症初次出现到开始治疗的时间通常过长。在过去20年里，有实证支持几种治疗神经性厌食症的方法的疗效。此外，以家庭为基础的治疗或个体心理治疗的门诊治疗对相当一部分患者有良好效果。早期干预可改善治疗结果，应成为所有患者的优先事项。门诊治疗通常是早期干预的最佳形式，而且已经证明，即使是患有严重或极重度神经性厌食症的患者，如果他们病情稳定，也可以作为门诊患者进行治疗。住院治疗比门诊治疗更具干扰性、成本更高，而且通常等候名单更长。决定是进行门诊治疗还是将患者转至住院治疗可能很困难。这篇观点综述的核心目的是提供安全开展神经性厌食症门诊治疗所需的知识基础。描述了门诊治疗的科学要点，包括如何评估和管理神经性厌食症的医疗风险以及如何决定何时需要转至住院治疗。讨论了以下几个方面：早期干预、神经性厌食症的门诊治疗，包括对严重和极重度神经性厌食症的门诊心理治疗、如何确定门诊治疗何时安全以及何时需要转至住院医疗。还讨论了新兴治疗方法、伦理问题和未解决的研究问题。
