Frequency of recovery from anorexia nervosa of a cohort patients re-evaluated on a long-term basis following intensive care

Abstract

The need to treat the acute onset of anorexia nervosa in a specialty unit is well known, but nevertheless, even "clinically recovered" patients show a high rate of relapse. The aim of our study was to re-evaluate various clinical (hemoglobin, transferrin, insulin-like growth factor I, TSH, PRL, gonadotropins and 17 beta-estradiol) and psychiatric [semistructured interview, Eating Disorder Inventory (EDI) Test] parameters in 19 female anorexic patients hospitalized in our department from 1983 to 1993 (with a 9-year median prior to the present study) for the treatment of anorexia nervosa, and to compare these results with those of a previous follow-up performed on the same subjects in 1993. In the present evaluation, no significant variation was found among the clinical, nutritional and hormonal parameters when compared to those of the first follow-up in which all parameters had improved with the exception of the PRL levels, which were significantly low. Meanwhile, the percentage of patients with spontaneous menses increased significantly from 50% to 70%, while the number of patients on psychopharmacological therapy decreased significantly throughout the study. Furthermore the percentage of patients with altered (severe or mild) EDI profiles decreased to 50%. This study emphasizes the positive prognostic role of hospitalization and intensive care in a cohort of anorexic patients. The present study, in addition to demonstrating both a general maintenance of body weight acquired over the years, albeit in the lower normal range, and an increase in the percentage of patients with a regular menstrual cycle, also highlights the persistence of psychiatric abnormalities in a large number of patients, even in those diagnosed as "clinically recovered", thus suggesting the need for long-term psychiatric care.

Outcome Predictors in Anorectic Patients after 6 Months of Multimodal Treatment

“…In outcome studies [1,3,5,6,19,[22][23][24][25][26][27], many different variables have been considered: sociodemographic elements (e.g. age, social class, schooling), anamnestic elements (e.g.…”

The Long Term Biological Consequences of Anorexia Nervosa

“…Three-years after stable weight recovery, Bertoli et al [52] found that 8 women with previous AN remained at just over 85% of their ideal body weight, which was also significantly less than control women. Foppiani et al [100] also reported body weight to fall in the lower range of normal nine years after hospitalisation for AN, despite a general maintenance of body weight. Another long-term study that reported on body weight in recovered women, but did not include a control group, found the mean BMI to be 22 kg/m 2 after six years [46].…”

“…The AN group did show elevated fasting free fatty acid levels, possibly as a result of continued dieting behavior, and two of them met criteria for impaired glucose tolerance [148]. A median of nine years after hospitalisation for AN, Foppiani et al [100] did not find any abnormalities in thyroid, insulinlike growth factor, prolactin or gonadotropin measurements. Thus, from these few studies, it appears there are no residual effects of having AN on these endocrine systems.…”

Quand et comment conduire une nutrition entérale au cours de l’anorexie mentale ?

“…Ce traitement se fait par voie veineuse. Il ne sera pas développé ici [1]. Le traitement de l'ostéoporose qui est la plus grave des complications chroniques nutritionnelles de l'anorexie mentale doit s'intégrer dans la prise en charge globale.…”

“…Dans tous les cas l'évaluation des apports doit tenir compte de l'alimentation spontanée en plus des apports de la NE. Mais il est nécessaire d'être prudent, et le niveau de renutrition doit être d'autant plus bas et prudent que la dénutrition est sévère [1,33]. Dans ce cas, les apports ne doivent pas dépasser 10 kcal/kg les premiers jours de la renutrition d'un grand dénutri (IMC ≤ 11), sous couvert pendant trois à quatre jours d'une forte supplémentation vitaminique et phosphorée pour laquelle aucune recommandation précise ne fait l'unanimité.…”