Le contrat de poids lors d'une hospitalisation pour anorexie mentale

Godart, Nathalie; Perdereau, Fabienne; Galès, O.; Agman, G.; Deborde, Anne-Sophie; Jeammet, P.

doi:10.1016/j.arcped.2005.02.030

Cited by 25 publications

(9 citation statements)

References 8 publications

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“…The inpatient programs differed slightly according to the centres and the age of the patients. A few of these programs are described in published papers [ 9 – 11 , 39 ]. Patients included in the current study had a target discharge weight that was determined at the beginning of treatment.…”

Section: Methodsmentioning

confidence: 99%

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Predictive factors of dropout from inpatient treatment for anorexia nervosa

Roux

Ali

Lambert³

et al. 2016

BMC Psychiatry

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BackgroundPatients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets.MethodsFrom 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions.ResultsWe found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the “dietary restriction” subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q “restraint concerns” subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status.ConclusionTo prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.

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Section: Methodsmentioning

confidence: 99%

“…Dropouts were classified either as “early” (before the half-way mark in weight gain between admission and discharge, i.e., with very low weight and consequently high somatic risk) or “late” (after this half-way mark with a better nutritional status), according to the period in which they occurred in the process of weight gain [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Predictive factors of dropout from inpatient treatment for anorexia nervosa

Roux

Ali

Lambert³

et al. 2016

BMC Psychiatry

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“…Prior to inclusion in the study, all participants were hospitalized in our care unit for life-threatening physical and/or mental states (including BMI below 14 and or rapid weight loss and/or compromised vital functions, severe depression, high suicide risk, chronic under-nutrition with low weight, and failure of out-patient care). Once the patient was admitted, the objectives of hospitalization were defined by means of a weight contract establishing a discharge target weight [29], [32], [33]. For each patient hospitalized between January 1999 and July 2002, a screening file sheet was completed by a psychiatrist not involved in the patient's treatment (NG or FP) but in collaboration with the patient's clinicians.…”

Section: Methodsmentioning

confidence: 99%

“…Consisted in ambulatory care initiated before hospital discharge and was tailored according to the mental and physical state of the patient [29], [32], [33]. It included individual consultations, regular interviews involving the parents, and, if required, individual psychotherapy with another therapist.…”

Section: Methodsmentioning

confidence: 99%

A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents

et al. 2012

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Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated.ObjectiveTo compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).MethodSixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization.ResultsAt 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10th percentile) and menstrual status.ConclusionsAdding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN.Trial RegistrationControlled-trials.com ISRCTN71142875

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“…Prior to inclusion in the study, all participants were hospitalized in our care unit for a life-threatening physical and/or mental state (for one or more of the following criteria: BMI below 14 and or rapid weight loss and/or compromised vital functions, severe depression, high suicide risk, chronic under-nutrition with low weight, and failure of out-patient care) according to international guidelines [7,34,35,36]. Once the patient was admitted, the objectives of hospitalization were defined by means of a weight contract establishing a discharge target weight [36,37,38]. For each patient hospitalized between January 1999 and July 2002, a screening file sheet was completed by a psychiatrist not involved in the patient's treatment (N.G.)…”

Section: Methodsmentioning

confidence: 99%

Bonding and Expressed Emotion: Two Interlinked Concepts?

Duclos

Maria²,

Dorard³

et al. 2012

Psychopathology

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Background: Bonding and expressed emotion (EE) are two concepts modeling family relationships. Two studies, with contradictory results, have explored whether these concepts and their corresponding instruments [the Parental Bonding Instrument (PBI) and the Camberwell Family Interview] do indeed measure the same aspects of family relationships. Our first objective was to compare the adolescents' perceptions of family relationships using the PBI, and the parental viewpoint using the Five-Minute Speech Sample (FMSS-EE). Secondly, we compared the PBI scores and EE levels of the parents. Sampling and Methods: Sixty adolescent girls with anorexia nervosa completed the PBI. The FMSS and a modified version of the PBI were administered to parents separately. Results: No significant link was identified between adolescent PBI scores and parental EE levels. However, a link between maternal ‘modified' PBI scores and maternal EE was observed: when mothers registered a high Final EE, they were more likely to deny their daughter's psychological autonomy compared to mothers with lower EE. Conclusions: Our empirical results do not support the hypothesis of an overlap between the two concepts. Indeed bonding and EE measure the same object, i.e. the quality of family relationships, but time scales differ and so do the perspectives (patient vs. parental viewpoint).

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Le contrat de poids lors d'une hospitalisation pour anorexie mentale

Cited by 25 publications

References 8 publications

Predictive factors of dropout from inpatient treatment for anorexia nervosa

Predictive factors of dropout from inpatient treatment for anorexia nervosa

A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents

Bonding and Expressed Emotion: Two Interlinked Concepts?

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