Predictive factors of length of inpatient treatment in anorexia nervosa

Dept. of Psychiatry for Adolescents and Young Adults, Site Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
European Child & Adolescent Psychiatry (Impact Factor: 3.34). 10/2008; 18(2):75-84. DOI: 10.1007/s00787-008-0706-8
Source: PubMed


To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN).
We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS.
Mean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder.
The identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance.

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Available from: Nathalie Godart
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    • "A 25-year review of eating disorder admissions in Iceland reported an average length of hospital stay of 67.3 days in AN adults and 129.7 days in AN adolescents (Sigurdardottir et al. 2010). Similarly, in France, a retrospective review of a large, specialist child and adolescent eating disorder unit reported a mean length of stay of 135 days (Stirk Lievers et al. 2009), whereas in a multi-center RCT of adolescent AN treatment in the UK, the average length of hospitalization was 106.4 days (Gowers et al. 2010). In the USA, where hospital admission for AN is often limited to medically unstable patients, lengths of stay tend to be brief. "
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    ABSTRACT: The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN) and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3) admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year after being discharged. Assessments were made at the beginning and at the end of the inpatient treatment as well as at the 1-year follow-up. Self-rating data and expert-rating interview data were obtained. Adequate data for 55 (96.5%) cases allowed for the assignment of an outcome category. A total of 28.1% of the patients' cases showed a good outcome, meaning the patients fully recovered, and 8.8% had an intermediate outcome, and 59.6% of the patients' cases had a poor outcome. Significant predictors of poor outcome included the patient's BMI at the beginning of the treatment as well as psychiatric comorbidity, and purging behavior. Adolescent AN is a severe disorder with a poor outcome in a substantial amount of adolescents.
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    ABSTRACT: The aim is to study if the determination of target weights in a clinical therapeutic contract which guides weight gain for adolescent inpatients with anorexia nervosa (AN) is based on clearly pre-defined, objective clinical elements. Treating psychiatrists completed patient information questionnaires for 139 anorexic adolescent inpatients. These questionnaires included information related to factors that the clinical team had hypothesized to be decisive in weight contract determination. Comparative statistical procedures evaluated whether these factors were in fact decisive in clinical practice. The two weight objectives comprising our therapeutic contract (separation end weight and final discharge weight) were significantly related to the clinical variables tested: separation end weight was explained by the theoretical separation end weight, the range of contract, and the desires of the patient and her parents; final discharge weight was explained by patient body mass index before AN and by the desires of the patient and her parents. The therapeutic contract is based on objective criteria and implemented by our team in accordance with its theoretical design. It is therefore possible to establish goal weights in a defined and reliable manner.
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