Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial

Herpertz‐Dahlmann, Beate; Schwarte, Reinhild; Krei, Melanie; Egberts, Karin; Warnke, Andreas; Wewetzer, Christoph; Pfeiffer, E. F.; Fleischhaker, Christian; Scherag, André; Holtkamp, Kristian; Hagenah, Ulrich; Konrad, Kerstin; Schmidt, Ulrike; Schade‐Brittinger, Carmen; Timmesfeld, Nina; Dempfle, Astrid

doi:10.1016/s0140-6736(13)62411-3

Cited by 229 publications

(262 citation statements)

References 36 publications

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“…A previous qualitative study suggests that patients experience benefits from their parents participating in these interventions. 220 The increase in BMI (2.1 kg/m 2 , 14% increase) at 1 year is smaller than that found in early intervention cases given inpatient/day patient care (3 kg/m 2 ), 193 ]. On the other hand, the reduction (17%) in ED psychopathology is less than that seen in outpatient care (38%).…”

Section: Discussionmentioning

confidence: 91%

“…The study found similar 1-year weight outcomes between the forms of treatment, but with less expense and better social adjustment with the inpatient/day patient intervention. 193 This suggests that reducing the time separated from the family may be of benefit.…”

Section: Introductionmentioning

confidence: 99%

“…Duration of inpatient care also varies in different health-care systems, with longer durations of admissions in European countries than in the USA. 193 Although patients usually manage to gain weight in hospital, deterioration and relapse following inpatient treatment is common and typically occurs within the first year of treatment. Approximately 30-50% of those who remit relapse.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

Self Cite

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“…Inpatient treatment programs are usually multidisciplinary and treatment focuses on weight restoration, normalizing eating behavior and facilitating psychological change through nutritional education, supervised meals and individual and group psychotherapy [18,19] . In published trials admissions have been prolonged with a length of stay ranging from several months to 15.2 wk [22][23][24] . Partial hospitalization or day programs are similar to inpatient treatment in terms of a multidisciplinary approach, treatments offered and intensity and duration of treatment but with no overnight stays [22] .…”

Section: Introductionmentioning

confidence: 99%

Systematic review of evidence for different treatment settings in anorexia nervosa

Madden

Hay

Touyz

2015

WJP

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AIM:To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS:Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms "anorexia nervosa" and "treatment" dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS:Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION:There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa. Core tip: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. This study compared outcomes in AN treatment studies comparing different treatment settings: inpatient, day-patient and outpatient. Five studies were identified. There was no difference in outcomes between the different settings and lengths of inpatient treatment. Both outpatient and day-patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was cheaper than prolonged inpatient care for weight normalization. There is support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting.

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“…While a direct comparison of this coefficient with that detected by Coners et al is not possible (use of premorbid age percentile for BMI versus premorbid BMI), the magnitude of the correlation appears quite similar. Most recently, Föcker et al [6] used a multivariate statistical model including the independent variables age, duration of illness, duration of treatment, BMI at admission and BMI percentile at discharge in their analysis based on 161 patients of the (see [10], for a detailed description of the patient sample) with a mean age of 15.2 ± 1.5 years. Again, the relationship between premorbid BMI percentile and BMI at admission was solidly confirmed.…”

mentioning

confidence: 99%

Identification of determinants of referral and follow-up body mass index of adolescent patients with anorexia nervosa: evidence for the role of premorbid body weight

Hebebrand

2015

Eur Child Adolesc Psychiatry

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Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial

Cited by 229 publications

References 36 publications

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Systematic review of evidence for different treatment settings in anorexia nervosa

Identification of determinants of referral and follow-up body mass index of adolescent patients with anorexia nervosa: evidence for the role of premorbid body weight

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