Inpatient versus Day Clinic Treatment for Bulimia Nervosa: A Randomized Trial

Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Hauptstrasse 8, Freiburg, Germany.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 04/2009; 78(3):152-60. DOI: 10.1159/000206869
Source: PubMed


In bulimia nervosa, more intense treatments are recommended if outpatient treatment fails. This is the first randomized controlled trial comparing the options of inpatient versus day clinic treatment.
Patients with severe bulimia nervosa were randomly assigned to inpatient or day clinic treatment of similar length and intensity. Specific and general psychopathology was assessed at the end of treatment and a 3-month follow-up.
Fifty-five patients were randomized; 22 day clinic patients and 21 inpatients started the program. At the end of treatment, a significant reduction of general and specific pathology was found in both settings. Following discharge, there was more deterioration in bulimic symptoms after inpatient treatment, but overall, results were comparable.
Inpatient and day clinic programs are effective treatments for severely disturbed bulimic patients with similar results at the 3-month follow-up. Further follow-up will show if a higher instability of results after inpatient treatment is of importance in the long term.

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    • "Advantages of day hospital treatment include the daily transfer of experiences (home ↔ hospital) and an emphasis on self-reliance. This might allow an easier transfer of experiences into everyday life and reduce the risk for relapse (Zeeck et al., 2009c, 2009d; Mörtl, von Wietersheim, 2008). However, inpatient treatment can be considered more " safe and containing " as patients are accommodated in their own rooms and staff is available for 24 hours. "
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    ABSTRACT: AbstractBackground In major depression (MDD), hospital treatment is an option in more severe cases or if outpatient treatment failed. Psychosomatic hospitals in Germany provide treatment programs with multimodal psychotherapy, either in an inpatient or a day hospital setting. In the context of health care research, this study aimed 1) to compare characteristics of patients treated in psychosomatic day hospitals and inpatient units, 2) to compare the effectiveness of both treatment modalities. Methods A naturalistic design was chosen to achieve external validity. 604 consecutive patients were assessed at admission, discharge and a 3-months follow-up. Primary outcome was defined as a reduction of depressive symptomatology (QIDS-C), secondary outcomes comprise overall functioning and quality of life. For a comparison of effectiveness, inpatient and day hospital samples were matched according to known predictors of outcome. Results The few differences found between the inpatient and day hospital sample were related to severity of depression and physical impairment. Inpatients more often got antidepressant medication. Additionally, inpatients were treated significantly longer, due to a subgroup of patients with somatic co-morbidity. There were no differences when comparing effectiveness. Limitations When comparing treatment effectiveness, possible bias cannot be ruled out. There was no randomization or untreated control group. Conclusions In patients with a more severe depression and somatic co-morbidity, inpatient treatment might be preferred as compared to day hospital treatment. However, most patients can be treated in both settings.
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    • "In part, this is reflected in the cultural and temporal changes in the use of inpatient treatment and the variation in service level treatment parameters in Europe [3] and in the USA and Canada [4]. More recently, day patient services (typically a 9–5pm programme, 5 days a week with 2 or 3 meals) are being offered as an alternative to inpatient care (residential, 7 days a week with all meals), including in the UK [5] for those not at high medical risk [6-10]. A recent meta-analysis, which examined factors that predicted weight gain in anorexia nervosa (AN), concluded that inpatient care was associated with the fastest change [11]. "
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    ABSTRACT: Individual, family and service level characteristics and outcomes are described for adult and adolescent patients receiving specialist inpatient or day patient treatment for anorexia nervosa (AN). Potential predictors of treatment outcome are explored. Admission and discharge data were collected from patients admitted at 14 UK hospital treatment units for AN over a period of three years (adult units N = 12; adolescent N = 2) (patients N = 177). One hundred and seventy-seven patients with a severe and enduring illness with wide functional impairment took part in the study. Following inpatient care, physical improvement was moderate/good with a large increase in BMI, although most patients continued to have a clinical level of eating disorder symptoms at discharge. The potentially modifiable predictors of outcome included confidence to change, social functioning and carer expressed emotion and control. Overall, the response to inpatient treatment was modest particularly in the group with a severe enduring form of illness. Adolescents had a better response. Although inpatient treatment produces an improvement in physical health there was less improvement in other eating disorder and mood symptoms. As predicted by the carer interpersonal maintenance model, carer behaviour contributed to the response to inpatient care as did social functioning and confidence to change.
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