Relapse From Remission at Two- to Four-Year Follow-Up in Two Treatments for Adolescent Anorexia Nervosa

Abstract

Objective Long-term follow-up studies documenting maintenance of treatment effects are few in adolescent anorexia nervosa (AN). This exploratory study reports relapse from full remission and attainment of remission during a four-year open follow-up period using a convenience sample of a subgroup of 65% (n=79) from an original cohort of 121 participants who completed a randomized clinical trial comparing family based therapy (FBT) and adolescent focused individual therapy (AFT). Method Follow-up assessments were completed up to four years posttreatment (average of 3.26 years). Available participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at two to four years posttreatment. Results Two participants (6.1%) relapsed (FBT: n = 1, 4.5%; AFT: n = 1, 9.1%), on average 1.98 years (SD = 0.14) after remission was achieved at one-year follow-up. Ten new participants (22.7%) achieved remission (FBT: n = 1, 5.9%; AFT: n = 9, 33.3%). Mean time to remission for this group was 2.01 years (SD = 0.82) from one-year follow-up. There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up. Other psychopathology was stable over time. Conclusion There were few changes in the clinical presentation of participants who were assessed at long-term follow-up. These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is achieved. Clinical trial registration information—Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa; http://www.clinicaltrials.gov/; NCT00149786.

Treatment of eating disorders in child and adolescent psychiatry

“…However, during the subsequent 4-year period, more patients in the AFT group had gained additional weight and had recovered from anorexia nervosa than those in the FBT group. Thus, although FBT works more quickly, AFT does not seem to be less effective in the long run [28]. Only 30% of the FBT group remained weight-restored at the 4-year follow-up (note, however, the high drop-out rate of more than one-third).…”

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

“…Nevertheless, some authors have denounced an "underfeeding syndrome" (22,23). Due to the lack of scientific evidence and risks of under and overfeeding, researchers have started to investigate feeding regimes in hospitalized adolescents with AN.…”

“…Moreover, some authors argue that initiating very low energy intakes can have deleterious effects on weight gain (8). Refeeding syndrome is caused by a correction of malnutrition which is too fast, but on the other hand, we also need to avoid underfeeding caused by a rate of refeeding which is too cautious (22,23).…”

Family-based Treatment of Child and Adolescent Eating Disorders

“…Compared with individual modalities, FBT shows better clinical outcomes, maintained across follow-up points. 9,[15][16][17] Data suggest that family therapy may confer a specific benefit to those with a shorter duration of illness (<3 years) and an onset before age 18 years. 9,15 Individuals receiving FBT were less likely to need hospitalization and had lower rates of relapse at 1-year follow-up.…”