Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

Abstract

Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains. Results One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. Conclusions Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.

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

“…This can be explained by the fact, that patients with a lower BMI at admission need to gain more weight and therefore also require a longer duration of inpatient stay. Previous studies postulated that the BMI at admission as an indicator of illness severity is a predictor of treatment response in terms of a better prognosis in patients with higher BMI at admission and discharge [ 63 , 66 ]. Furthermore, higher levels of eating disorder psychopathology at admission were also associated with longer duration of inpatient stay, which is consistent with the current literature [ 33 , 34 , 36 ].…”

“…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]. Current treatment guidelines tors to increase insight into the mechanisms of AN in order to improve current treatment interventions [37,40,[58][59][60][61][62][63]. However, the current evidence does not yet provide a sufficient picture on the factors relevant for favorable treatment outcome on the one hand [22,24,54,64,65], and optimal length of inpatient stay on the other hand [33][34][35][36], primarily due to the inconsistent results and high heterogeneity of the methods used.…”

“…As many patients with AN show an unfavorable treatment outcome, several previous studies focused on identifying underlying positive or negative prognostic factors to increase insight into the mechanisms of AN in order to improve current treatment interventions [ 37 , 40 , 58 , 59 , 60 , 61 , 62 , 63 ]. However, the current evidence does not yet provide a sufficient picture on the factors relevant for favorable treatment outcome on the one hand [ 22 , 24 , 54 , 64 , 65 ], and optimal length of inpatient stay on the other hand [ 33 , 34 , 35 , 36 ], primarily due to the inconsistent results and high heterogeneity of the methods used.…”

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

“…In fact, in spite of providing patients with specific discharge plans (6), a substantial number of patients require multiple hospitalizations, sometimes over a short period of time. There are few longitudinal studies in AN on inpatients, and RA is rarely considered as an outcome itself, with most works focusing instead on the stabilization/improvement of outcome measures at follow-up (8)(9)(10)(11). Earlier data suggested RAs as becoming increasingly frequent over time (12), but no other data are currently available for adults with AN.…”

Intensive Treatments in Adolescent Anorexia Nervosa

“…Against the background of an increasing prevalence of atypical AN [ 26 ], with weight loss mostly starting from a higher original weight, the determination of an individual target BMI may be more effective for growth and the resumption of menses than a standardized target weight. A higher BMI at discharge from IP seems to increase the likelihood of health maintenance [ 27 , 28 , 29 ].…”