Martinelli Mary K, Schreyer Colleen C, Guarda Angela S
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Eat Disord. 2024 Sep 4;12(1):132. doi: 10.1186/s40337-024-01092-y.
Anorexia nervosa (AN) is a severe psychiatric disorder, from which recovery is often protracted. The role of prior specialized inpatient treatment on subsequent treatment attempts for adults with chronic AN and predictors of treatment response for severe and enduring AN (SE-AN) are needed to improve outcomes.
Participants (N = 135) with chronic AN (ill ≥7 years) admitted to an integrated inpatient-partial hospitalization eating disorders (ED) unit with prior ED hospitalization(s) (+ PH; n = 100) were compared to those without prior ED hospitalizations (-PH; n = 35) on admission characteristics (BMI, length of illness, outpatient ED treatment history, symptomatology (ED, anxiety, and depressive), history of suicide attempts or non-suicidal self-injury (NSSI)), treatment motivation and recovery self-efficacy, and discharge outcomes (discharge BMI, rate of weight gain, length of stay, clinical improvement).
Groups were similar with regard to age, years ill, and admission BMI. The + PH group had lower desired weight, lifetime nadir BMI and self-efficacy for normative eating, and higher state and trait anxiety than the -PH group. +PH were also more likely to endorse history of NSSI and suicide attempt. Regarding discharge outcomes, most patients achieved weight restoration at program discharge (mean discharge BMI = 19.8 kg/m). Groups did not differ on rate of weight gain, likelihood of attending partial hospital, partial hospital length of stay, program discharge BMI, or likelihood of clinical improvement (p's > 0.05) although inpatient length of stay was longer for the + PH group.
Participants with chronic AN + PH exhibited more severe psychiatric comorbidity and lower self-efficacy for normative eating than AN -PH, however short-term discharge outcomes were similar. Future research should determine whether weight restoration and targeting comorbidities impacts relapse risk or need for rehospitalization among chronic and severe + PH. Despite similar illness durations, those with chronic AN -PH may be able to transition to partial hospital earlier. Conversely there is risk of undertreatment of chronic AN + PH given the recent shift promoting briefer self-directed admissions for adults with SE-AN. Research comparing + PH and -PH adults with chronic AN may facilitate efforts to individualize care and characterize relapse risk following intensive treatment.
神经性厌食症（AN）是一种严重的精神疾病，康复过程往往较为漫长。为改善治疗效果，需要了解先前的专科住院治疗对慢性AN成年患者后续治疗尝试的作用，以及严重持久性AN（SE-AN）治疗反应的预测因素。
将135例慢性AN（患病≥7年）患者纳入一个综合住院-部分住院的饮食失调（ED）单元，其中有过ED住院史（+PH；n = 100）的患者与无ED住院史（-PH；n = 35）的患者在入院特征（BMI、病程、门诊ED治疗史、症状（ED、焦虑和抑郁）、自杀未遂或非自杀性自伤（NSSI）史）、治疗动机和康复自我效能以及出院结局（出院BMI、体重增加率、住院时间、临床改善情况）方面进行比较。
两组在年龄、患病年限和入院BMI方面相似。+PH组的期望体重、终生最低BMI以及正常饮食的自我效能较低，且状态焦虑和特质焦虑高于-PH组。+PH组也更有可能认可NSSI和自杀未遂史。关于出院结局，大多数患者在项目出院时实现了体重恢复（平均出院BMI = 19.8kg/m²）。两组在体重增加率、参加部分住院治疗的可能性、部分住院治疗时间、项目出院BMI或临床改善可能性方面无差异（p值>0.05），尽管+PH组的住院时间更长。
慢性AN +PH患者比AN -PH患者表现出更严重的精神共病和更低的正常饮食自我效能，但短期出院结局相似。未来的研究应确定体重恢复和针对共病情况是否会影响慢性和严重+PH患者的复发风险或再次住院需求。尽管病程相似，但慢性AN -PH患者可能能够更早地过渡到部分住院治疗。相反，鉴于最近推动对SE-AN成年患者进行更简短的自我指导入院治疗的转变，慢性AN +PH患者存在治疗不足的风险。比较慢性AN +PH和 -PH成年患者的研究可能有助于努力实现个体化护理，并确定强化治疗后的复发风险特征。
