Abstract
This study aims to investigate possible different outcomes in the inpatient treatment of anorexia nervosa (AN) related to different timings of psychopharmacological and nutritional interventions. A retrospective observational study was conducted, involving young patients hospitalized for AN, treated with naso-gastric tube feeding (NGT). Participants were divided into five groups according to early (0–7 days) or late (8+ days) introduction of atypical antipsychotics (AAP) and NGT: early AAP-early NGT (EE), early AAP-late NGT (EL), late AAP-early NGT (LE), late AAP-late NGT (LL) and a control group treated with NGT only (NGT). Concurrent clinical and treatment variables were analyzed. AN psychopathology was measured with the Eating Disorder Inventory-3 (EDI-3) EDRC score. Outcomes were assessed as admission-discharge body-mass index (BMI) improvement and length of hospital stay (LOS). Contributions of variables related to outcomes were assessed with multifactorial-analyses of variance (MANOVA). Seventy-nine patients were enrolled in the study. LOS was different among treatment groups (F (4, 75) = 5.993, p < 0.001), and EE patients showed lower LOS than LE (p < 0.001) and LL (p = 0.025) patients. BMI improvement was not significantly different among treatment groups but correlated negatively with age (F (1, 72) = 10.130, p = 0.002), and admission BMI (F (1, 72) = 14.681, p < 0.001). In conclusion, patients treated with early AAP and early NGT showed lower LOS than those treated with late AAP. Prognostic treatment variables should be investigated in wider samples.
Highlights
Anorexia nervosa (AN) is a mental health condition, which is characterized by food avoidance with significant weight loss and altered perception of one’s own body and most commonly begins during childhood and adolescence [1]
For the purpose of this study, we considered the composite score eating disorder risk (EDRC) at of 11 admission, resulting from the combination of the subscales drive for thinness, bulimia,3and body dissatisfaction
The relationships and the relative weight of variables significantly associated with the outcome measures were studied with multifactorial-analyses of variance (ANOVA) (MANOVA), followed by single analyses of covariance (ANCOVA)
Summary
Anorexia nervosa (AN) is a mental health condition, which is characterized by food avoidance with significant weight loss and altered perception of one’s own body and most commonly begins during childhood and adolescence [1]. Even though inpatient treatment may promote weight restoration in AN regardless of the model of care provided, the most recent guidelines indicate the need for additional research to determine the critical treatment elements related to weight restoration [7]. Current guidelines mostly recommend nasogastric tube feeding (NGT) if a meal plan and supplemental nutrition drinks are not managed in malnourished patients [8,9,10,11]. Rapid weight restoration in underweight patients has been linked to such metabolic urgencies as refeeding syndrome [12]. Literature lacks guidance on the appropriate or advisable timing for specific interventions, such as NGT feeding, geared toward weight restoration in patients with AN
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