Skip to main content
Top
Published in: BioPsychoSocial Medicine 1/2014

Open Access 01-12-2014 | Research

The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization

Authors: Keisuke Kawai, Sakino Yamashita, Gen Komaki, Miki Shimizu, Megumi Nakashima, Samami Etou, Shu Takakura, Masato Takii, Chiharu Kubo, Nobuyuki Sudo

Published in: BioPsychoSocial Medicine | Issue 1/2014

Login to get access

Abstract

Background

This study was done to determine which psychosocial factors are related to the urgent hospitalization of anorexia nervosa patients (AN) due to extremely poor physical condition and to evaluate their outcome after inpatient treatment.

Methods

133 hospitalized AN patients were classified into an urgent hospitalization (n = 24) or a planned hospitalization (n = 109) group. Multiple regression analysis was done of clinical features, body mass index (BMI), psychological tests [The Minnesota Multiphasic Personality Inventory (MMPI), alexithymia, relationship with parents, and the Eating Disorder Inventory (EDI)]. The effectiveness of treatment was prospectively determined two years after discharge by the Global Clinical Score (GCS). The hospitalized weight gain and the frequency of outpatient visits were evaluated.

Results

Of the factors assessed, only BMI at admission was related to the necessity of urgent hospitalization (β = − 1.063, P = 0.00). The urgent group had significantly more weight loss after discharge and poorer social adaptation on the GCS, even when the patient had a sufficient increase in body weight during inpatient treatment and an equivalent number of outpatient consultations.

Conclusion

None of the parameters of the psychosocial tests studied were significantly different between the groups. The outcome of the urgent group was poor. Two years after discharge they had difficulty maintaining weight and continued to have poor social adaptation.
Appendix
Available only for authorised users
Literature
1.
go back to reference Treasure J, Claudino AM, Zucker N: Eating disorders. Lancet. 2010, 375 (9714): 583-593. 10.1016/S0140-6736(09)61748-7. PubMed PMID: 19931176. Epub 2009/11/26. engCrossRefPubMed Treasure J, Claudino AM, Zucker N: Eating disorders. Lancet. 2010, 375 (9714): 583-593. 10.1016/S0140-6736(09)61748-7. PubMed PMID: 19931176. Epub 2009/11/26. engCrossRefPubMed
2.
go back to reference Papadopoulos FC, Ekbom A, Brandt L, Ekselius L: Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009, 194 (1): 10-17. 10.1192/bjp.bp.108.054742. PubMed PMID: 19118319. Epub 2009/01/02. engCrossRefPubMed Papadopoulos FC, Ekbom A, Brandt L, Ekselius L: Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009, 194 (1): 10-17. 10.1192/bjp.bp.108.054742. PubMed PMID: 19118319. Epub 2009/01/02. engCrossRefPubMed
3.
go back to reference Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2009, 159 (8): 1284-1293. PubMed PMID: 12153817. Epub 2002/08/03. engCrossRef Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2009, 159 (8): 1284-1293. PubMed PMID: 12153817. Epub 2002/08/03. engCrossRef
4.
go back to reference Neumarker KJ: Mortality and sudden death in anorexia nervosa. Int J Eat Disord. 1997, 21 (3): 205-212. 10.1002/(SICI)1098-108X(199704)21:3<205::AID-EAT1>3.0.CO;2-O. PubMed PMID: 9097194. Epub 1997/04/01. engCrossRefPubMed Neumarker KJ: Mortality and sudden death in anorexia nervosa. Int J Eat Disord. 1997, 21 (3): 205-212. 10.1002/(SICI)1098-108X(199704)21:3<205::AID-EAT1>3.0.CO;2-O. PubMed PMID: 9097194. Epub 1997/04/01. engCrossRefPubMed
5.
go back to reference American Psychiatric Association (APA): Practice guideline for the treatment of patients with eating disorders. 2006, 27-31. 2006/08/24, 3 American Psychiatric Association (APA): Practice guideline for the treatment of patients with eating disorders. 2006, 27-31. 2006/08/24, 3
7.
go back to reference Kawai K, Yamashita S, Yamanaka T, Gondo M, Morita C, Nozaki T, Takakura S, Hata T, Yamada Y, Matsubayashi S, Takii M, Kubo C, Sudo N: The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: a case control study. Biopsychosoc Med. 2011, 5: 14-10.1186/1751-0759-5-14. PubMed PMID: 22142436. Pubmed Central PMCID: 3275451. Epub 2011/12/07. engPubMedCentralCrossRefPubMed Kawai K, Yamashita S, Yamanaka T, Gondo M, Morita C, Nozaki T, Takakura S, Hata T, Yamada Y, Matsubayashi S, Takii M, Kubo C, Sudo N: The longitudinal BMI pattern and body composition of patients with anorexia nervosa who require urgent hospitalization: a case control study. Biopsychosoc Med. 2011, 5: 14-10.1186/1751-0759-5-14. PubMed PMID: 22142436. Pubmed Central PMCID: 3275451. Epub 2011/12/07. engPubMedCentralCrossRefPubMed
8.
go back to reference First MBSR, Gibbon M, Williams JB: Structured Clinical Interview for Axis I Disorder DSM-VI -Patient Edition- (SCID-I/P). 1995, Biometric Research Department: New York NYSPI First MBSR, Gibbon M, Williams JB: Structured Clinical Interview for Axis I Disorder DSM-VI -Patient Edition- (SCID-I/P). 1995, Biometric Research Department: New York NYSPI
9.
go back to reference Dahlstrom WG, Welsh GS, Dahlstrom LE: An MMPI Handbook: A Guide to use in Clinical Practice and Research. 1972, Minneapolis: Press UoM Dahlstrom WG, Welsh GS, Dahlstrom LE: An MMPI Handbook: A Guide to use in Clinical Practice and Research. 1972, Minneapolis: Press UoM
10.
go back to reference Komaki G, Arimura T, Nakata A, Shinoda H, Ogata I, Shimura M, Kawamura NKC: The reliability and factorial validity of the Japanese version of the 20-item Toronto Alexithymia Scale (TAS-20). Jap J Psychosom Med. 2003, 43: 839-846. Komaki G, Arimura T, Nakata A, Shinoda H, Ogata I, Shimura M, Kawamura NKC: The reliability and factorial validity of the Japanese version of the 20-item Toronto Alexithymia Scale (TAS-20). Jap J Psychosom Med. 2003, 43: 839-846.
11.
go back to reference Bagby RM, Parker JD, Taylor GJ: The twenty-item Toronto Alexithymia Scale–I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994, 38 (1): 23-32. 10.1016/0022-3999(94)90005-1. PubMed PMID: 8126686. Epub 1994/01/01. engCrossRefPubMed Bagby RM, Parker JD, Taylor GJ: The twenty-item Toronto Alexithymia Scale–I. Item selection and cross-validation of the factor structure. J Psychosom Res. 1994, 38 (1): 23-32. 10.1016/0022-3999(94)90005-1. PubMed PMID: 8126686. Epub 1994/01/01. engCrossRefPubMed
12.
go back to reference Parker G: The parental bonding instrument: psychometric properties reviewed. Psychiatr Dev. 1989, 7 (4): 317-335. PubMed PMID: 2487899. Epub 1989/01/01. engPubMed Parker G: The parental bonding instrument: psychometric properties reviewed. Psychiatr Dev. 1989, 7 (4): 317-335. PubMed PMID: 2487899. Epub 1989/01/01. engPubMed
13.
go back to reference Garner DM, Olmsted MA, Polivy J: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983, 2 (2): 15-34. 10.1002/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6.CrossRef Garner DM, Olmsted MA, Polivy J: Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J Eat Disord. 1983, 2 (2): 15-34. 10.1002/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6.CrossRef
14.
go back to reference Amemiya N, Takii M, Hata T, Morita C, Takakura S, Oshikiri K, Urabe H, Tokunaga S, Nozaki T, Kawai K, Sudo N, Kubo C: The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit. Eat Weight Disord. 2012, 17 (1): e1-e8. PubMed PMID: 21997338. Epub 2011/10/15. engPubMed Amemiya N, Takii M, Hata T, Morita C, Takakura S, Oshikiri K, Urabe H, Tokunaga S, Nozaki T, Kawai K, Sudo N, Kubo C: The outcome of Japanese anorexia nervosa patients treated with an inpatient therapy in an internal medicine unit. Eat Weight Disord. 2012, 17 (1): e1-e8. PubMed PMID: 21997338. Epub 2011/10/15. engPubMed
15.
go back to reference Garfinkel PE, Moldofsky H, Garner DM: The outcome of anorexia nervosa: significance of clinical features, body image, and behavior modification. Anorexia Nervosa. Edited by: Vigersky RA. 1977, New York: Raven Press, 315-329. Garfinkel PE, Moldofsky H, Garner DM: The outcome of anorexia nervosa: significance of clinical features, body image, and behavior modification. Anorexia Nervosa. Edited by: Vigersky RA. 1977, New York: Raven Press, 315-329.
16.
go back to reference Yamashita S, Kawai K, Yamanaka T, Inoo T, Yokoyama H, Morita C, Takii M, Kubo C: BMI, body composition, and the energy requirement for body weight gain in patients with anorexia nervosa. Int J Eat Disord. 2010, 43 (4): 365-371. PubMed PMID: 19459214. Epub 2009/05/22. engPubMed Yamashita S, Kawai K, Yamanaka T, Inoo T, Yokoyama H, Morita C, Takii M, Kubo C: BMI, body composition, and the energy requirement for body weight gain in patients with anorexia nervosa. Int J Eat Disord. 2010, 43 (4): 365-371. PubMed PMID: 19459214. Epub 2009/05/22. engPubMed
17.
go back to reference Giel KE, Kullmann S, Preissl H, Bischoff SC, Thiel A, Schmidt U, Zipfel S, Teufel M: Understanding the reward system functioning in anorexia nervosa: crucial role of physical activity. Biol Psychol. 2013, 94 (3): 575-581. 10.1016/j.biopsycho.2013.10.004. PubMed PMID: 24161801CrossRefPubMed Giel KE, Kullmann S, Preissl H, Bischoff SC, Thiel A, Schmidt U, Zipfel S, Teufel M: Understanding the reward system functioning in anorexia nervosa: crucial role of physical activity. Biol Psychol. 2013, 94 (3): 575-581. 10.1016/j.biopsycho.2013.10.004. PubMed PMID: 24161801CrossRefPubMed
18.
go back to reference Zipfel S, Mack I, Baur LA, Hebebrand J, Touyz S, Herzog W, Abraham S, Davies PS, Russell J: Impact of exercise on energy metabolism in anorexia nervosa. J Eat Disord. 2013, 1 (1): 37-10.1186/2050-2974-1-37. PubMed PMID: 24499685PubMedCentralCrossRefPubMed Zipfel S, Mack I, Baur LA, Hebebrand J, Touyz S, Herzog W, Abraham S, Davies PS, Russell J: Impact of exercise on energy metabolism in anorexia nervosa. J Eat Disord. 2013, 1 (1): 37-10.1186/2050-2974-1-37. PubMed PMID: 24499685PubMedCentralCrossRefPubMed
19.
go back to reference Hebebrand J, Himmelmann GW, Herzog W, Herpertz-Dahlmann BM, Steinhausen HC, Amstein M, Seidel R, Deter HC, Remschmidt H, Schafer H: Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am J Psychiatry. 1997, 154 (4): 566-569. PubMed PMID: 9090350. Epub 1997/04/01. engCrossRefPubMed Hebebrand J, Himmelmann GW, Herzog W, Herpertz-Dahlmann BM, Steinhausen HC, Amstein M, Seidel R, Deter HC, Remschmidt H, Schafer H: Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am J Psychiatry. 1997, 154 (4): 566-569. PubMed PMID: 9090350. Epub 1997/04/01. engCrossRefPubMed
20.
go back to reference Kawai K, Yamashita S, Gondo M, Morita C, Arimura C, Nozaki T, Takii M, Kubo C: Somatic and psychological factors related to the body mass index of patients with anorexia nervosa. Eat Weight Disord. 2009, 13: 198-204.CrossRef Kawai K, Yamashita S, Gondo M, Morita C, Arimura C, Nozaki T, Takii M, Kubo C: Somatic and psychological factors related to the body mass index of patients with anorexia nervosa. Eat Weight Disord. 2009, 13: 198-204.CrossRef
21.
go back to reference Rask-Andersen M, Olszewski PK, Levine AS, Schioth HB: Molecular mechanisms underlying anorexia nervosa: focus on human gene association studies and systems controlling food intake. Brain Res Rev. 2010, 62 (2): 147-164. 10.1016/j.brainresrev.2009.10.007. PubMed PMID: 19931559. Epub 2009/11/26. engCrossRefPubMed Rask-Andersen M, Olszewski PK, Levine AS, Schioth HB: Molecular mechanisms underlying anorexia nervosa: focus on human gene association studies and systems controlling food intake. Brain Res Rev. 2010, 62 (2): 147-164. 10.1016/j.brainresrev.2009.10.007. PubMed PMID: 19931559. Epub 2009/11/26. engCrossRefPubMed
22.
go back to reference Quinton ND, Meechan DW, Brown K, Eastwood H, Blakemore AI: Single nucleotide polymorphisms in the leptin receptor gene: studies in anorexia nervosa. Psychiatr Genet. 2004, 14 (4): 191-194. 10.1097/00041444-200412000-00004. PubMed PMID: 15564891. Epub 2004/11/27. engCrossRefPubMed Quinton ND, Meechan DW, Brown K, Eastwood H, Blakemore AI: Single nucleotide polymorphisms in the leptin receptor gene: studies in anorexia nervosa. Psychiatr Genet. 2004, 14 (4): 191-194. 10.1097/00041444-200412000-00004. PubMed PMID: 15564891. Epub 2004/11/27. engCrossRefPubMed
23.
go back to reference Ando T, Kodama N, Ishikawa T, Naruo T, Tachikawa N, Nozaki T, Okabe K, Takeuchi K, Masuda A, Kawamura N, Komaki G: Uncoupling protein-2/uncoupling protein-3 gene polymorphism is not associated with anorexia nervosa. Psychiatr Genet. 2004, 14 (4): 215-218. 10.1097/00041444-200412000-00009. PubMed PMID: 15564896. Epub 2004/11/27. engCrossRefPubMed Ando T, Kodama N, Ishikawa T, Naruo T, Tachikawa N, Nozaki T, Okabe K, Takeuchi K, Masuda A, Kawamura N, Komaki G: Uncoupling protein-2/uncoupling protein-3 gene polymorphism is not associated with anorexia nervosa. Psychiatr Genet. 2004, 14 (4): 215-218. 10.1097/00041444-200412000-00009. PubMed PMID: 15564896. Epub 2004/11/27. engCrossRefPubMed
24.
go back to reference Zipfel S, Wild B, Gross G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Lowe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog Won behalf of Antop study group: Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet. 2014, 383 (9912): 127-137. 10.1016/S0140-6736(13)61746-8. PubMed PMID: 24131861CrossRefPubMed Zipfel S, Wild B, Gross G, Friederich HC, Teufel M, Schellberg D, Giel KE, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Lowe B, Tagay S, von Wietersheim J, Zeeck A, Schade-Brittinger C, Schauenburg H, Herzog Won behalf of Antop study group: Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet. 2014, 383 (9912): 127-137. 10.1016/S0140-6736(13)61746-8. PubMed PMID: 24131861CrossRefPubMed
25.
go back to reference Morgan HG, Hayward AE: Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br J Psychiatry. 1988, 152: 367-371. 10.1192/bjp.152.3.367. PubMed PMID: 3167372CrossRefPubMed Morgan HG, Hayward AE: Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br J Psychiatry. 1988, 152: 367-371. 10.1192/bjp.152.3.367. PubMed PMID: 3167372CrossRefPubMed
26.
go back to reference Cooper Z, Cooper PJ, Fairburn CG: The validity of the eating disorder examination and its subscales. Br J Psychiatry. 1989, 154: 807-812. 10.1192/bjp.154.6.807. PubMed PMID: 2597887CrossRefPubMed Cooper Z, Cooper PJ, Fairburn CG: The validity of the eating disorder examination and its subscales. Br J Psychiatry. 1989, 154: 807-812. 10.1192/bjp.154.6.807. PubMed PMID: 2597887CrossRefPubMed
Metadata
Title
The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization
Authors
Keisuke Kawai
Sakino Yamashita
Gen Komaki
Miki Shimizu
Megumi Nakashima
Samami Etou
Shu Takakura
Masato Takii
Chiharu Kubo
Nobuyuki Sudo
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2014
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/1751-0759-8-20

Other articles of this Issue 1/2014

BioPsychoSocial Medicine 1/2014 Go to the issue