Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study.
Relapse is common among recovered anorexia nervosa (AN) patients. Studies on relapse prevention with an average follow-up period of 18 months found relapse rates between 35 and 41 %. In leading guidelines there is general consensus that relapse prevention in patients treated for AN is a matter of essence. However, lack of methodological support hinders the practical implementation of relapse prevention strategies in clinical practice. For this reason we developed the Guideline Relapse Prevention Anorexia Nervosa. In this study we examine the rate, timing and predictors of relapse when using this guideline.



Cohort study with 83 AN patients who were enrolled in a relapse prevention program for anorexia nervosa with 18 months follow-up. Data were analyzed using Kaplan-Meijer survival analyses and Cox regression.



Eleven percent of the participants experienced a full relapse, 19 % a partial relapse, 70 % did not relapse. Survival analyses indicated that in the first four months of the program no full relapses occurred. The highest risk of full relapse was between months 4 and 16. None of the variables remained a significant predictor of relapse in the multivariate Cox regression analysis.



The guideline offers structured procedures for relapse prevention. In this study the relapse rates were relatively low compared to relapse rates in previous studies. We recommend that all patients with AN set up a personalized relapse prevention plan at the end of their treatment and be monitored at least 18 months after discharge. It may significantly contribute to the reduction of relapse rates.
Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705 WJ, Zeist, The Netherlands. t.berends@altrecht.nl.
Tamara
T
Berends
Department of Health, Sports & Welfare, Cluster Nursing, Inholland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands.|Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.|Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands.
Berno
B
van Meijel
Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705 WJ, Zeist, The Netherlands.|Parnassia Psychiatric Institute, Clinical Centre for Acute Psychiatry, the Hague, The Netherlands.
Willem
W
Nugteren
Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands.|Institute of Psychology, Methodology and Statistics Unit, Leiden University, Leiden, The Netherlands.
Mathijs
M
Deen
Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705 WJ, Zeist, The Netherlands.|Utrecht Research Group Eating Disorders, Utrecht, The Netherlands.
Unna N
UN
Danner
Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands.|Utrecht Research Group Eating Disorders, Utrecht, The Netherlands.|Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, USA.
Hans W
HW
Hoek
Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705 WJ, Zeist, The Netherlands.|Utrecht Research Group Eating Disorders, Utrecht, The Netherlands.|Department of Social Sciences, Utrecht University, Utrecht, The Netherlands.
Annemarie A
AA
van Elburg
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000517:prevention & control / Q000628:therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
Anorexia nervosa; Relapse; Relapse intervention; Relapse prevention; Survival analysis