Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
Highlights
Anorexia nervosa (AN) may have onset in childhood, adolescence is recognized as a important life stage in the development of this eating disorder (ED), with 20% to 40% of all new cases having their onset during this time [1]
Against the background of an increasing prevalence of atypical anorexia nervosa (AN) [26], with weight loss mostly starting from a higher original weight, the determination of an individual target BMI may be more effective for growth and the resumption of menses than a standardized target weight
We investigated the course and outcome of AN during a stepped care treatment program of inpatient treatment (IP) followed by home treatment (HoT) until a 1-year follow-up
Summary
Anorexia nervosa (AN) may have onset in childhood, adolescence is recognized as a important life stage in the development of this eating disorder (ED), with 20% to 40% of all new cases having their onset during this time [1]. 3. Refeeding One of the main reasons for admission to the hospital is severe underweight or marked weight loss in a rather short period of time, such as in atypical AN. In a recent randomized controlled trial (RCT) including 120 adolescents and young adults between 12 and 24 years, a high-calorie diet, defined as 2000 kcal/d at the beginning of refeeding and an additional 200 kcal every day, was compared to a lower-calorie diet, starting with 1400 calories and an augmentation of 200 kcal every other day. The main outcome in this study was medical stability, defined as a higher heart rate and a higher blood pressure (45 beats/min and >90 mmHg, respectively), a higher body temperature, less postural increase of heartbeat and orthostatic decrease in blood pressure and a higher body weight (75% of the mean body mass index (BMI) for the patient’s sex and age). Nutritional advice has proven to be very supportive for adolescents in re-establishing healthy eating behavior and gaining and maintaining weight
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
