Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high‐quality, cost‐effective services?

Abstract

The aim of this paper is to consider how changes in service planning and delivery might improve the care pathways for adult anorexia nervosa. Although anorexia nervosa has a long history in Europe, its framing as a mental disorder is quite recent. The changing forms and increasing epidemiology of eating disorders has led to the expansion of specialised services. Although some services provide care over the entire clinical course, more often services are divided into those that care for children and adolescents or adults. The transition needs to be carefully managed as currently these services may have a different ethos and expectations. Services for adults have a broad range of diversity (diagnostic subtype, medical severity, comorbidity, stage of illness and psychosocial functioning) all of which impacts on prognosis. A tailored, approach to treatment planning could optimise the pathway. Facilitating early help seeking and rapid diagnosis in primary care and reducing specialised services waiting lists for assessment and treatment could be a form of secondary prevention. The use of precision models and /or continuous outcome monitoring might reduce the third of patients who require more intensive care by applying augmentation strategies. Finally, gains from intensive care might be sustained by relapse prevention interventions and community support to bridgeThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Rehospitalization and “Revolving Door” in Anorexia Nervosa: Are There Any Predictors of Time to Readmission?

“…The transition between inpatient and outpatient services has long been considered a possible contributing cause of frequent RAs with estimates of a lack of a link to outpatient care after an acute hospitalization ranging from 22 to 90% (40). In this vein, interventions that bridge the transition home, thus, increasing community support, have been recently authoritatively advocated for AN (41). On the other hand, it should also be noted that individualized discharge plans could have helped avoid even more rapid patterns of RAs; in fact, different from earlier studies on general psychiatry (42), the first month since hospital discharge was not a critical period for RA.…”

Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome

“…Of concern, although in line with the literature (25)(26)(27), is that more that the half of the patients had remained underweight or returned to underweight at follow-up. These troubling findings underline the need of new therapeutic strategies to better treat severely ill patients and prevent relapse, and intensify research in this field (28).…”

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

“…Especially female adolescents between 15 and 19 years are affected by AN with a postulated decrease in the age of onset [7,[15][16][17][18]. Recent reviews reported a better prognosis in children and adolescents compared to patients with first-onset AN in adulthood, which emphasizes the need for early recognition, diagnosis and treatment to prevent relapse and a chronic, protracted, or enduring course of this disorder [19][20][21][22][23][24]. The complex phenomenology of this illness and its long enduring course of over 20 years in more than half of those affected, requires specially adapted treatment concepts to increase remission and recovery rates [1,3,5,24].…”

“…The intensity of the treatment setting should be adapted to the severity of the disorder, taking into account comorbidities and medical complications. Outpatient psychological/psychotherapeutic treatment involving family members (e.g., family-based treatment, parent-focused treatment, systemic family therapy, enhanced cognitive-behavioral therapy, focal psychodynamic therapy) should be the first step, eventually followed by day clinic and inpatient treatment [ 1 , 3 , 19 , 25 , 26 ]. The current recommendations for consideration of inpatient treatment include a body-mass-index (BMI) below the 3rd percentile, rapid weight loss, low energy intake, refusal to drink, medical complications, severe psychiatric comorbidity, dysfunctional family interactions, and insufficient response to outpatient treatment [ 25 , 26 , 27 ].…”