A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents
Identifieur interne : 000093 ( Main/Exploration ); précédent : 000092; suivant : 000094A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents
Auteurs : S. Madden [Australie] ; J. Miskovic-Wheatley [Australie] ; A. Wallis [Australie] ; M. Kohn [Australie] ; J. Lock [États-Unis] ; D. Le Grange [États-Unis] ; B. Jo [États-Unis] ; S. Clarke [Australie] ; P. Rhodes [Australie] ; P. Hay [Australie] ; S. Touyz [Australie]Source :
- Psychological Medicine [ 0033-2917 ] ; 2014.
Abstract
Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.
We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).
The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (
Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
Url:
DOI: 10.1017/S0033291714001573
PubMed: 25017941
PubMed Central: 4301212
Affiliations:
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Madden</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Eating Disorder Service at The Sydney Children's Hospitals Network</institution>,<addr-line>Westmead</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Discipline of Pediatrics, Faculty of Medicine</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Miskovic Wheatley, J" sort="Miskovic Wheatley, J" uniqKey="Miskovic Wheatley J" first="J." last="Miskovic-Wheatley">J. 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Lock</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Psychiatry and Behavioral Science, School of Medicine</addr-line>,<institution>Stanford University</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Le Grange, D" sort="Le Grange, D" uniqKey="Le Grange D" first="D." last="Le Grange">D. Le Grange</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Psychiatry and Behavioral Neuroscience</addr-line>,<institution>The University of Chicago</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Jo, B" sort="Jo, B" uniqKey="Jo B" first="B." last="Jo">B. Jo</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Psychiatry and Behavioral Science, School of Medicine</addr-line>,<institution>Stanford University</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Clarke, S" sort="Clarke, S" uniqKey="Clarke S" first="S." last="Clarke">S. Clarke</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit</addr-line>,<institution>Westmead Hospital</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Rhodes, P" sort="Rhodes, P" uniqKey="Rhodes P" first="P." last="Rhodes">P. Rhodes</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>School of Psychology</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hay, P" sort="Hay, P" uniqKey="Hay P" first="P." last="Hay">P. Hay</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Centre for Health Research, School of Medicine</addr-line>,<institution>The University of Western Sydney and School of Medicine, James Cook University</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Touyz, S" sort="Touyz, S" uniqKey="Touyz S" first="S." last="Touyz">S. 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Madden</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Eating Disorder Service at The Sydney Children's Hospitals Network</institution>,<addr-line>Westmead</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Discipline of Pediatrics, Faculty of Medicine</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Miskovic Wheatley, J" sort="Miskovic Wheatley, J" uniqKey="Miskovic Wheatley J" first="J." last="Miskovic-Wheatley">J. Miskovic-Wheatley</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Eating Disorder Service at The Sydney Children's Hospitals Network</institution>,<addr-line>Westmead</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Westmead Clinical School</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Wallis, A" sort="Wallis, A" uniqKey="Wallis A" first="A." last="Wallis">A. Wallis</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Eating Disorder Service at The Sydney Children's Hospitals Network</institution>,<addr-line>Westmead</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Kohn, M" sort="Kohn, M" uniqKey="Kohn M" first="M." last="Kohn">M. Kohn</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Eating Disorder Service at The Sydney Children's Hospitals Network</institution>,<addr-line>Westmead</addr-line>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Discipline of Pediatrics, Faculty of Medicine</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit</addr-line>,<institution>Westmead Hospital</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lock, J" sort="Lock, J" uniqKey="Lock J" first="J." last="Lock">J. Lock</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Psychiatry and Behavioral Science, School of Medicine</addr-line>,<institution>Stanford University</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Le Grange, D" sort="Le Grange, D" uniqKey="Le Grange D" first="D." last="Le Grange">D. Le Grange</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Psychiatry and Behavioral Neuroscience</addr-line>,<institution>The University of Chicago</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Jo, B" sort="Jo, B" uniqKey="Jo B" first="B." last="Jo">B. Jo</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Psychiatry and Behavioral Science, School of Medicine</addr-line>,<institution>Stanford University</institution>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Clarke, S" sort="Clarke, S" uniqKey="Clarke S" first="S." last="Clarke">S. Clarke</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Centre for Research into Adolescents’ Health (CRASH), Adolescent Medicine Unit</addr-line>,<institution>Westmead Hospital</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Rhodes, P" sort="Rhodes, P" uniqKey="Rhodes P" first="P." last="Rhodes">P. Rhodes</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>School of Psychology</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hay, P" sort="Hay, P" uniqKey="Hay P" first="P." last="Hay">P. Hay</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Centre for Health Research, School of Medicine</addr-line>,<institution>The University of Western Sydney and School of Medicine, James Cook University</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Touyz, S" sort="Touyz, S" uniqKey="Touyz S" first="S." last="Touyz">S. Touyz</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>School of Psychology</addr-line>,<institution>The University of Sydney</institution>,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Psychological Medicine</title><idno type="ISSN">0033-2917</idno><idno type="eISSN">1469-8978</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec_a1"><title>Background</title><p>Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.</p></sec><sec id="sec_a2" sec-type="methods"><title>Method</title><p>We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).</p></sec><sec id="sec_a3" sec-type="results"><title>Results</title><p>The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (<sc>s.d.</sc>) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.</p></sec><sec id="sec_a4" sec-type="conclusion"><title>Conclusions</title><p>Outcomes are similar with hospitalizations for MS or WR when combined with FBT. 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Madden</name></noRegion><name sortKey="Clarke, S" sort="Clarke, S" uniqKey="Clarke S" first="S." last="Clarke">S. Clarke</name><name sortKey="Hay, P" sort="Hay, P" uniqKey="Hay P" first="P." last="Hay">P. Hay</name><name sortKey="Kohn, M" sort="Kohn, M" uniqKey="Kohn M" first="M." last="Kohn">M. Kohn</name><name sortKey="Kohn, M" sort="Kohn, M" uniqKey="Kohn M" first="M." last="Kohn">M. Kohn</name><name sortKey="Kohn, M" sort="Kohn, M" uniqKey="Kohn M" first="M." last="Kohn">M. Kohn</name><name sortKey="Madden, S" sort="Madden, S" uniqKey="Madden S" first="S." last="Madden">S. Madden</name><name sortKey="Miskovic Wheatley, J" sort="Miskovic Wheatley, J" uniqKey="Miskovic Wheatley J" first="J." last="Miskovic-Wheatley">J. Miskovic-Wheatley</name><name sortKey="Miskovic Wheatley, J" sort="Miskovic Wheatley, J" uniqKey="Miskovic Wheatley J" first="J." last="Miskovic-Wheatley">J. Miskovic-Wheatley</name><name sortKey="Rhodes, P" sort="Rhodes, P" uniqKey="Rhodes P" first="P." last="Rhodes">P. Rhodes</name><name sortKey="Touyz, S" sort="Touyz, S" uniqKey="Touyz S" first="S." last="Touyz">S. Touyz</name><name sortKey="Wallis, A" sort="Wallis, A" uniqKey="Wallis A" first="A." last="Wallis">A. Wallis</name></country><country name="États-Unis"><noRegion><name sortKey="Lock, J" sort="Lock, J" uniqKey="Lock J" first="J." last="Lock">J. Lock</name></noRegion><name sortKey="Jo, B" sort="Jo, B" uniqKey="Jo B" first="B." last="Jo">B. Jo</name><name sortKey="Le Grange, D" sort="Le Grange, D" uniqKey="Le Grange D" first="D." last="Le Grange">D. Le Grange</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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