[Total symptom-oriented and psychodynamic concept in inpatient treatment of anorexia nervosa. A quasi-experimental comparative study of 40 admission episodes].
Inpatient treatment programs for severely anorectic patients often combine or integrate psychodynamic approaches with an explicit focus on symptoms. There is a dearth of studies evaluating treatments, let alone in a controlled way. In a quasi-experimental design we compare the normalization of body weight in the 20 consecutive admission episodes before ("PD") and the 20 episodes after ("PD & SY") introduction and integration of explicit symptom orientation derived from the St. Georges model (Crisp 1980) on a psychoanalytically oriented psychosomatic ward. All patients fulfill ICD-10 criteria for either restrictive (F50.00) or bulimic (F50.01) anorexia nervosa. In addition to AN(C)OVAS growth curve modelling and multi state analysis, a variant of survival analysis, are used to model the shape and temporal course of treatment responses. Clinical features at admission and total duration of treatment and drop-out rates are comparable. The PD & SY group reaches target weight significantly more frequently (14 vs. 5 episodes, p = 0.023) and with a much higher total probability (0.70 vs. 0.25 in the PD group, Cox regression p = 0.002). After a phase of adaptation the treatment team feels relieved by the more systematically structured approach and is now able to treat a far larger number of patients. It does not seem justifiable anymore to withhold anorectic patients explicitely symptom-oriented treatment components. These and other conclusions for clinical practice and research are discussed.
Herzog
T
T
Abteilung Psychotherapie und Psychosomatische Medizin Albert-Ludwigs-Universität Freiburg.
Hartmann
A
A
Falk
C
C
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D001828:Body Image; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission; D010348:Patient Care Team; D011575:Psychoanalytic Therapy; D016896:Treatment Outcome; D015430:Weight Gain