Day Hospital Program Research Articles

Patients with persistent symptoms after COVID-19 attending a multidisciplinary evaluation: Characteristics, medical conclusions, and satisfaction

ObjectiveAmong patients attending a multidisciplinary day-hospital program for persistent symptoms after COVID-19, we aimed i) to describe their characteristics ii) to present the medical conclusions (diagnoses and recommendations) and iii) to assess the patients' satisfaction and its correlates. MethodsFor this retrospective chart review study, frequent symptoms were systematically assessed. Standardized questionnaires explored fatigue (Pichot scale), physical activity (Ricci & Gagnon scale), health-related quality of life (Short-Form Health Survey), anxiety and depressive symptoms (Hospital Anxiety and Depression scale) and associated psychological burden (Somatic-Symptom-Disorder B criteria Scale). Medical record conclusions were collected and a satisfaction survey was performed at 3-months follow-up. ResultsAmong 286 consecutive patients (median age: 44 years; 70% women), the most frequent symptoms were fatigue (86%), breathlessness (65%), joint/muscular pain (61%) and cognitive dysfunction (58%), with a median duration of 429 days (Inter-quartile range (IqR): 216–624). Questionnaires revealed low levels of physical activity and quality of life, and high levels of fatigue, anxiety, depression, and psychological burden, with 32% and 23% meeting the diagnostic criteria for a depressive or anxiety disorder, respectively. Positive arguments for a functional somatic disorder were found in 76% of patients, including 96% with no abnormal clinical or test findings that may explain the symptoms. Physical activity rehabilitation was recommended for 91% of patients. Patients' median satisfaction was 8/10 (IqR: 6–9). ConclusionMost patients attending this program presented with long-lasting symptoms and severe quality of life impairment, received a diagnosis of functional somatic disorder, and reported high levels of satisfaction regarding the program.

Triangulation study of needs assessment of people with severe mental illness in "follow-up" day hospital settings.

The aim of research was to assess the needs of patients with severe mental illness (SMI) attending follow-up day hospital (DH) programmes from the patients', relatives' and experts' perspective. This triangulation research relies on three sources of information and two techniques of data collection. Qualitative research was conducted comprising semi-structured interviews (n=15) and focus groups (n=4) in three sequential rounds, triangulating patients', relatives' and experts' views. A content analysis was carried out. Study reveals a diverse spectrum of needs of SMI patients in follow-up DH programmes. The analysis yielded six themes: optimal daily functioning, work and educational activities, social network inclusion, continuous treatment, support and guidance, long-term care. DH programmes should assess the needs of patients with SMI and be adapted according to the findings. In addition to clinical treatment, requirements for continuous treatment, psychological and social needs, therapeutic relationship in less-restrictive settings should be considered.

Effects of Music Therapy in the Reduction of Pre-Meal Anxiety in Patients Suffering from Anorexia Nervosa

Literature reviews appear to indicate that Music Therapy (MT) may instil a sense of empowerment and generate feelings of renewed self-confidence, distracting subjects who follow this type of intervention from negative thoughts and, generally, helping patients suffering from Anorexia Nervosa (AN) to redevelop or rediscover their identity. The purpose of the study reported in this paper is to investigate whether MT proposed before an evening meal is capable of decreasing pre-meal anxiety in adolescents suffering from AN who follow the Day-hospital Treatment Programme at the San Bortolo Hospital of Vicenza (Italy). A total of 24 patients participated voluntarily in once-weekly sessions of group-based MT conducted by a qualified music therapist over a period of six months. Before evening meals on Monday, Tuesday and Wednesday, pre-meal anxiety was measured using a self-report scale, and the MT group session occurred every Wednesday before the evening meal was consumed. MT activities were both active and receptive. It has been found that with respect to Mondays and Tuesdays, pre-meal anxiety was significantly lower on Wednesdays following participation in the MT group. MT is evidently capable of reducing pre-meal anxiety and may be adopted as a supportive element in treatment plans relating to patients with AN in a day-hospital treatment programme.

Prevalence of partial remission of eating disorders at 6, 12, 18 and 24 months in a day hospital program. Associated factors

Rationale: Eating Disorders (ED) present a high prevalence. This study evaluates the remission of ED in a Day Hospital Program (DHP) based on systemic therapy. Objective: to assess the partial remission of ED after 6, 12, 18 and 24 months of treatment and its related factors

Program Expansion of a Day Hospital Dedicated to Manage Sickle Cell Pain

Background: Vaso-occlusive crisis (VOC) is the hallmark complication of sickle cell disease (SCD). The majority of SCD-related healthcare costs in the United States, estimated at $2.4 billion annually, is attributed to frequent emergency room (ER) visits and hospitalizations due to recurrent VOC (1-3). A day hospital (DH) dedicated to manage uncomplicated VOC reduces admission rates, decreases length of stay (LOS) for inpatient admissions, and saves hospital costs (4 , 5). Most DH programs have hours of operation from 9 am to 5 pm, and programs with extended hours are limited. The impact of extended hours of DH programs on patient care is less clear.Methods: The Comprehensive Sickle Cell Center at the University of Illinois at Chicago (UIC) started a DH program to manage uncomplicated VOC in 2009 that was open from 8 am-5 pm Monday through Friday. To improve patient access and decrease the burden on the ER, the hours of operation were increased to 8 am-11 pm in February, 2014. Data on VOC-related patient visits to the DH and ER and admissions to the inpatient floors for calendar years 2012- 2016 were collected from the electronic medical record and evaluated. Descriptive statistics, the Cochrane trend test and Jonckheere-Terpstra trend test were used for data analysis.Results: The number of the DH visits increased from 208 visits in to 1058 visits in 2016. The proportion of the DH visits compared to the ER visits during the same time period showed a trend of significant increase (p<0.0001; Figure 1A). The numbers of unique patients served in the DH (66 in 2012 to 164 in 2016) also had a greater progressive increase compared to in the ER (115 in 2012 to 185 in 2016) (p=0.0012; Figure 1B). With increasing utilization of the DH, the inpatient admission rate from the DH over the 5-year span decreased (24% in 2012 to 14% in 2016; p<0.0001) (Figure 2A). The LOS for inpatient admissions from either the ER or DH due to a VOC also significantly decreased after program expansion (p<0.0001) (Figure 2B).Summary: Here we show that expanding the operation hours of a DH program increased its utilization by SCD patients by almost 5-fold. This was accompanied by a decreased hospital admission rate from the DH and a decrease in LOS for inpatient admissions, which may represent significant cost savings. A major advertising campaign to promote the UIC Comprehensive Sickle Cell center during the same time period may also contribute to the increasing patient visits in both DH and ER, but the incremental increase in the DH utilization over the ED most likely reflects the impact of expanded hours in the DH. Further expansion of the DH program may offer more benefits to patients with SCD.Reference:1. K. L. Hassell, Am J Prev Med38, S512 (Apr, 2010).2. S. Lanzkron, C. P. Carroll, C. Haywood, Jr., Am J Hematol85, 797 (Oct, 2010).3. T. L. Kauf, T. D. Coates, L. Huazhi, N. Mody-Patel, A. G. Hartzema, Am J Hematol84, 323 (Jun, 2009).4. L. J. Benjamin, G. I. Swinson, R. L. Nagel, Blood95, 1130 (Feb 15, 2000).5. A. H. Adewoye, V. Nolan, L. McMahon, Q. Ma, M. H. Steinberg, Haematologica92, 854 (Jun, 2007). [Display omitted] DisclosuresHsu:AstraZeneca: Other: steering committee for HESTIA trial; Emmi: Other: consultant for Emmi. Gordeuk:Emmaus Life Sciences: Consultancy.

Results of a Day-Hospital Program for Personality Disorders. Application of the PID-5 and DSM-5 Dimensional Model

DSM-5 dimensional-hybrid model and PID-5 Personality Inventory might be particularly useful in a day hospital treatment program for personality disorders, while the need for treatment for mixed personality disorder and unspecified personality disorder is such as frequent as for borderline personality disorder. Effective treatment programs in the public health system are required. The study shows the results from the day hospital treatment program for personality disorders implemented at San Juan Hospital in Alicante. The treatment involves an intensive and interdisciplinary program that applies the DSM-5 dimensional model and the PID-5 personality inventory to identify therapeutic needs, with both individual and group therapies with a cognitive-behavioural therapeutic approach. Results support the relevance of therapeutic components regarding this program. Moreover, its effectiveness has been demonstrated in achieving significant changes in symptoms, traits, comorbidity, and psychosocial functioning. It also appears to be efficient not only in reducing the number of visits to the emergency and hospital admissions, but also in ensuring continuity and therapeutic compliance, thus reducing public health costs.

Clinical and Cognitive Functioning Changes After Partial Hospitalization in Patients With Anorexia Nervosa.

Introduction: Anorexia nervosa is usually associated with emotional and cognitive difficulties. Little knowledge is available about the changes in cognitive functioning in patients undergoing treatments. The aim of the present study was to longitudinally assess the impact of partial hospitalization on clinical and cognitive functioning in anorexia nervosa.Materials and Methods: 56 women with anorexia nervosa according to DSM-5 criteria and 58 healthy women were enrolled in the study. At baseline, all participants underwent clinical, diagnostic and neuropsychological assessment (T0). Patients were also assessed at the end of the treatment program (T1; n = 56).Results: BMI improved significantly throughout treatment. At baseline, patients showed significantly poorer executive abilities and less specific autobiographical memory. After the day-hospital program, decision-making abilities improved significantly. Response to treatment was predicted by BMI at admission and duration of illness, but neuropsychological performance did not contribute to the prediction model.Discussion: Cognitive difficulties, mostly regarding executive functions, resulted differently affected by clinical improvement. In particular, while cognitive monitoring and cognitive inhibition appear to be mostly stable trait-like characteristics, decision-making is both more state-dependent and sensitive to clinical status. None of the cognitive variables added information about the response to day hospital treatment; patients with short duration of illness and a rapidly decreasing BMI would benefit more from intensive interventions than less “acute” patients. These observations, if confirmed by future studies, have important clinical implications in order to understand the impact of malnutrition on cognitive functioning and to provide individualized effective treatment for patients with anorexia nervosa.

Is It Worth It? A Comparison of an Intensive Interdisciplinary Pain Treatment and a Multimodal Treatment for Youths With Pain-related Disability.

The objective of this study was to evaluate the effectiveness of an intensive interdisciplinary pain treatment (IIPT) day-hospital program as compared with an outpatient multimodal treatment (MMT) for youth with chronic pain. A nonrandomized pretest posttest with control group design was used. A battery of patient-oriented measures assessing pain interference, quality of life, and depressive symptoms were completed at treatment commencement and at 3, 6, and 12 months after treatment by 44 youths enrolled in the IIPT and 138 youths engaged in the MMT, with various chronic pain conditions. Data were analyzed using longitudinal mixed-effects models. The main outcomes were the score difference from baseline of patient-oriented measures across 3 timepoints within 12 months of intervention initiation for both treatment groups. IIPT participants demonstrated greater improvement in pain interference, as compared with MMT at 3 and 12 months. Initially, health-related quality of life scores improved similarly in both groups, but greater improvement was seen in the MMT group at 12 months. Depressive symptom scores did not improve with either intervention. Only pain interference scores reached statistically and clinically significant difference levels. This study supports the benefits of specialized rehabilitation interventions, including both MMT and IIPT programs, for youths with chronic pain. The findings also suggest that IIPT might have a greater long-term effect for helping youths, in particular those with high pain interference scores.

Naturalistic outcomes for a day-hospital programme in a mixed diagnostic sample of adolescents with eating disorders.

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.

Comparison of Clinical and Sociodemographic Characteristics of Patients with Schizophrenia Treated Stationary and at Day Hospital

Schizophrenia is a disorder that can disrupt practically every aspects of human functioning. It is a chronic disorder which can cause serious difficulties even at the level of elementary functioning for the affected individual and his/her family. Until twenty years ago, main goal of schizophrenia treatment was practically entirely directed on reducing positive symptoms, with significant residual deficits, such as negative symptoms, cognitive impairment, coping difficulties in everyday life situations, impaired social and working aspects of everyday life. Today the aim of treatment is deinstitutionalisation, fewer number of relapses, reduced number of hospitalizations, as well as improved personal, family, social and work functionality, which can all be achieved by treating patients suffering from schizophrenia in the day hospital setting, in other words – with partial hospitalization. The goal of this research was to investigate and compare differences and specificities of sociodemographic and clinical features in two groups of patients suffering from schizophrenia, those treated in a stationary setting and those who attended a day-hospital program. The study also attempted to identify and compare the differences between these two groups of patients, as well as compare the efficacy of treatment of the two treatment modalities while using a questionnaire designed specifically for the purpose of this research. The study included 60 patients suffering from schizophrenia, who formed two groups of 30 patients and was entirely performed at the Department of Psychiatry of KBC Sestre milosrdnice. The hypothesis of this research was that patients suffering from schizophrenia treated in a day hospital setting have fewer hospitalizations than patients treated in an acute psychiatric ward. Results confirmed this hypothesis, as there was a statistically significant difference in the number of hospitalizations between the two groups of patients. By comparing these two groups, it can be concluded that patients treated in the day hospital have a higher level of education, are less work impaired and and are treated at an early stage of their illness (up to 5 years of treatment) compared to patients treated at the acute psychiatric ward. Compared to patients treated in the day hospital setting, patients treated acutely in general have a lower level of education, increased hereditary loading and aggressiveness, as well as longer treatment duration (about 10 years) and discontinued (irregular) course of outpatient treatment. By comparing data obtained from these two groups of patients with schizophrenia we can shape guidelines that will help us in everyday nursing practice.

Psychological Meanings of Eating Disorders and Their Association With Symptoms, Motivation Toward Treatment, and Clinical Evolution Among Outpatients.

Unlike patients suffering from egodystonic disorders, people with eating disorders sometimes attribute positive meanings to their symptoms, and this attribution process contributes to the maintenance of the disorder. This study aims at exploring psychological meanings of eating disorders and their associations with symptoms, motivation toward treatment, and clinical evolution. Eighty-one adults with an eating disorder (anorexia nervosa, n = 46 and bulimia nervosa, n = 35) treated in a day-hospital program were asked, each week over an 8-week period, to identify the psychological meanings they ascribed to their eating disorder. Avoidance was the most frequently identified meaning, followed by mental strength, security, death, confidence, identity, care, and communication. Avoidance was more frequently mentioned by participants with bulimia than in cases of anorexia. Security and mental strength were associated with less motivation toward treatment. Death was associated with more depressive and anxious symptoms. An exploratory factor analysis showed that these meanings formed three main dimensions: Avoidance, Intrapsychic, and Relational. Findings suggest that psychological meanings associated with eating disorders can be assessed and used as a clinical tool to increase treatment acceptability and effectiveness.

Staff perspectives: What is the function of adult mental health day hospital programs?

Introduction Despite the benefits of psychiatric day hospitals (DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care. Method Twenty-five DH staff members completed semi-structured qualitative interviews. Two independent coders applied content analysis to achieve data saturation. Results Four major themes emerged: (1) program purpose and function, (2) what is in a name, (3) perceived patient motivation, and (4) room for improvement. Discussion Findings highlighted the importance of a multidisciplinary team delivering education and skill-focused interventions. Services were cited as "bridging" different mental health settings. Challenges included barriers to treatment access and inadequate length of treatment. Implications for Practice Understanding the function and purpose of this treatment service may enhance service delivery by enabling programs to integrate identified key ingredients. Providers can also note treatment duration and consider how to best use that time. Finally, language used within a DH setting appears to impact staff delivering services, and may also alter patients' understanding of the services they will receive and purpose of the program.

Implementation of evidence-based treatments for borderline personality disorder: The impact of organizational changes on treatment outcome of mentalization-based treatment.

The quality of implementation of evidence-based treatment programs for borderline personality disorder (BPD) in routine clinical care is a neglected issue. The first aim of this mixed-method naturalistic study was to explore the impact of organizational changes on treatment effectiveness of a day-hospital programme of mentalization-based treatment. Consecutively referred BPD patients were divided into a pre-reorganization cohort (PRE-REORG) and a cohort during reorganization (REORG). Psychiatric symptoms (Brief Symptom Inventory) and personality functioning (Severity Indices of Personality Problems-118) before treatment and at 18- and 36-month follow-up were compared using multilevel modelling. Effect sizes in the PRE-REORG cohort were approximately twice as large at 18months (PRE-REORG: range 0.81-1.22; REORG: range 0.03-0.71) and three times as large at 36months (PRE-REORG: range 0.81-1.80; REORG: range 0.27-0.81). The quantitative results of this study suggest that even when mentalization-based treatment is successfully implemented and the structure of the programme remains intact, major organizational changes may have a considerable impact on its effectiveness. Second, we aimed to explore the impact of the reorganization on adherence at organizational, team and therapist level. The qualitative results of this study indicate that the organizational changes were negatively related to adherence to the treatment model at organizational, team and therapist level, which in turn was associated with a decrease in treatment effectiveness. The implications of these findings for the implementation of effective treatments for BPD in routine clinical practice are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

Effectiveness of a Respiratory Day Hospital Program to Reduce Admissions for Exacerbation in Patients with Severe COPD: A Prospective, Multicenter Study

ABSTRACTThe respiratory Day Hospital (DH) is a care facility currently operating at various healthcare institutions. It monitors patients with severe chronic obstructive pulmonary disease (COPD) presenting repeated exacerbations with at least two hospital admissions per year. The main aim of the study was to evaluate the effectiveness of the DH program for controlling admissions for COPD exacerbations in this cohort of patients, and to identify clinical factors associated with hospitalizations and mortality. An observational prospective multicenter study was carried out at three hospitals. The sample comprised 150 consecutive patients (median age 70 [65–76] years, FEV1 33 [26–43]%, 97% males), included at the DH program. Over a one-year period, variables assessing effectiveness and use of healthcare resources were recorded. Factors associated with hospitalizations and mortality were identified. Patients made a median of 4[2–5] emergency visits due to COPD exacerbations with a median of 1[0–2] hospitalization(s)/year. Most of exacerbations (77%) were evaluated at the DH, but there were fewer hospitalizations from the DH than from the emergency department (21% vs. 81%, p < 0.001). In all, 29% of the patients had at least two admissions; these were the patients with the most severe disease. Age, readmission at 30-days and the presence of respiratory failure were the predictors of mortality. In conclusion, the DH program is an effective model for reducing hospitalizations in this cohort of patients. In all, 29% of the patients required two hospital admissions or more; these patients had more advanced disease and poorer prognosis, and would be most likely to benefit from additional care support.

The Role of Conformity in Relation to Cohesiveness and Intimacy in Day-Hospital Groups of Patients with Schizophrenia.

ObjectiveConformity is defined as the act of adjusting one's behavior to match the social responses of others. Patients with schizophrenia often adjust their maladaptive behaviors by conforming in group treatment settings. This study aimed to examine whether the opinions of group members influence conformity of patients with schizophrenia who attend day-hospital programs.MethodsNineteen patients with schizophrenia from four different day-hospital programs and 23 healthy controls from four different social clubs completed the homographic meaning choice task under conditions of prior exposure to the pseudo-opinions of their group members, strangers, and unknown information sources. Group influences on conformity were observed when the level of group cohesiveness was high and the level of intimacy was low across participant groups.ResultsControls did not exhibit a significant effect of group influence on conformity, whereas patients were significantly influenced by their group members when making conformity-based decisions despite significantly lower intimacy and cohesiveness levels.ConclusionThese findings suggest that unlike controls, patients with schizophrenia tend to respond with conformity when influenced by the opinions of their affiliated group. In patients with schizophrenia group conformity may be used to select a more accurate decision and to enhance feelings of affiliation among them.

A study on the effectiveness of E-Mental Health in the treatment of psychosis: Looking to recovery

IntroductionAn integrated program (Institutional Psychiatric Open Light Treatment) for psychosis and personality disorder was enriched with audiovisual functions provided through a dedicated website.The aim of the present study was to observe how and if these added functions support the patients in their daily living, influencing the quality of the recovery process.Recent studies highlighted how telemental health services are effective to provide access, improve basic outcome, facilitate empowerment of patients and be well-accepted (Hilty, 2013; Hailey, 2008) and how integrated community-based treatment, such as Community-Based Psychodynamic Treatment Program (Chiesa and Fonagy, 2009) or Assertive Community Treatment (Veldhuizen and Bahler, 2013) are effective in SMI.Telemental health services may become factors improving real-life functioning, integrating community-based treatment for psychosis and bettering social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services, so positively affecting outcomes of psychosis treatment.MethodsAll patients admitted (May 2010–April 2015) were included. Aged between 18 and 65, with schizophrenia, psychosis, schizoaffective disorder, bipolar disorder, personality disorder.Some troubles with the website use (Voice2Voice) led to a second version, more friendly and simple to use (app2gether).App2gether provided several functions: audio/video conference rooms for patients or family (synchronous virtual space to interact, at scheduled time, with a psychologist, a psychiatrist or a peer support worker, in free groups); chat (asynchronous virtual space for any question or information).We considered primary outcomes proposed by Cochrane Collaboration (Shek, 2010): hospital admissions, days of hospitalization, day-hospital admissions, day-program attendance (e.g. weekly), treatment compliance (voluntary discharge or missing scheduled date).We considered, as secondary outcomes, variables closely associated with real-life functioning (Galderisi, 2015): global functioning (Italian translation of Global Assessment of Functioning Scale), quality of life (Short Form 36 item), social relationships (Personal and Social Performance), internalized stigma (Internalized Stigma Mental Illness Inventory), empowerment (Empowerment Scale).Patients were divided into four cohorts:– 1-using “app2gether” functions in the follow-up, attending day treatment program (n = 35);– 2-attending day treatment program (n = 52);– 3-attending transitional day-hospital program (n = 171);– 4-not included in the IPOLT-program (n = 188).Patients were included in the first group only based on their basic computer skills and fast Internet availability.ResultsAt first, we compared (2) and (3) with (4), as control group. For each patient, we considered an identical observation period before and after day-hospital admission (ANOVA, P &lt; 0.05).We found a significant improvement in primary outcomes and global functioning, but not in other secondary outcomes, for the groups (2) and (3) compared with (4).Over 6-months observation, patients using “app2gether” functions in the follow-up showed:– a significantly decrease in hospital admissions and hospitalization length, compared to non-IPOLT-program group;– a reduction in day-hospital admissions and day-hospital attendance, compared to (2) and (3) groups;– a notable effect on secondary outcomes, compared to all other groups.ConclusionA dedicated website in the IPOLT-program supports patients in their living's place, does not interfere with daily activities, decreases social costs, encourages community integration and reduces stigma.Synchronous telepsychiatry allow a professionally modulated intervention in “here and now”; asynchronous contacts with specialists combine professional intervention with chances of autonomy and autoregulation. These services reduce costs, in terms of FTE (Full Time Equivalent), but not the efficacy.Future advances in the websites should be designed, simplifying the contact surface with the treating-team and reducing the social impact of therapeutic practice.A better understanding of the complex variables influencing real-life functioning and new sensitive tools to detect it are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cohesion to the group and its association with attendance and early treatment response in an adult day-hospital program for eating disorders: A preliminary clinical investigation

Treatment outcome studies demonstrate that day-hospital programs are effective in the treatment of eating disorders. Few descriptions are available on the specifics of treatment, particularly the process of therapy. The group therapy modality is thought to provide important therapeutic benefits. The present study aimed to examine the association between individuals' cohesion to the group, attendance and early treatment response at a day-hospital program for eating disorders. A total of 36 women were recruited upon admission to the Eating Disorders Day Treatment Program (EDDTP). Cohesion and motivation were assessed at the beginning of treatment. Treatment response was measured after 12-weeks and attendance was recorded daily. Participation in the day-hospital program was associated with improvements in eating disorder symptoms and related pathology, consistent with international treatment outcome studies. Compatibility, which is a distinct aspect of cohesion, was found to be associated with attendance and treatment response. Clinical implications pertaining to the findings are discussed and areas of future research suggested.

Day hospital programmes for eating disorders: A review of the similarities, differences and goals

Day hospital (DH) treatments for eating disorders (EDs) provide intensive daily care and allow patients to maintain and test their social relations and coping skills at home and outside. Although widespread, their description is lacking. This review compares the different types of DH described in the literature and presents our DH experience in Turin, Italy. We searched Psychinfo and Pubmed with the following keywords: anorexia nervosa, bulimia nervosa, EDs, DH, day treatment and partial hospitalisation. We found and reviewed the DH programmes of eleven specialised centres, which have some shared features but also many differences, suggesting that DH treatments are still largely experimental. Briefly, the shared elements are: biopsychosocial model as reference frame; cognitive-behavioural model or techniques; behavioural contract; patients' selection; body image therapy; involvement of family; weight normalisation/weight gain and modification/normalisation of eating behaviour as objectives. Nonetheless, shared opinions concerning inclusion criteria are lacking; the duration of DH treatment is surprisingly different among centres (from 3 to 39 weeks); the approach to eating and compensation behaviours ranges from control to autonomy; followup and psychometric assessment can be either performed or not; psychological and behavioural objectives can be different. This review suggests the existence of two different DH models: the first has a shorter duration and is mainly symptom-focused; the second is more individual-focused, has a longer duration and is focused on patients' relational skills, psychodynamic understanding of symptoms and more gradual changes in body weight. Further investigation is required to make DH treatment programmes measurable and comparable.

Treatment of anorexia nervosa in a specialty care continuum

Inpatient hospitalization has been a mainstay of treatment for anorexia nervosa (AN), but decreasing lengths of inpatient stay have prompted the development of alternative care-continuum models. This study characterizes the 6-month outcomes of 71 patients with AN who completed an inpatient-treatment protocol (approximately 5 weeks), followed by a day-hospital program (DHP) (approximately 3 weeks). Data were derived from chart reviews and questionnaire data were collected during routine clinical care. On discharge from DHP, 35.2% of patients showed excellent outcomes, whereas 23.9% exhibited poor outcomes. At 6 months after DHP discharge, 47.9% of the patients were successful in maintaining outpatient treatment status. Patients with successful 6-month outcomes were admitted to inpatient at a higher weight, had fewer previous hospitalizations, were younger, were rated by inpatient staff as more committed to treatment, endorsed less AN psychopathology during inpatient admission, and showed greater weight gain during DHP. Number of previous hospitalizations and weight gain immediately after inpatient discharge predicted 89.2% of outcome classifications 6 months after DHP discharge. These findings highlight both the potential benefits of this care-continuum model for patients who previously have not been hospitalized and the pressing need to develop alternative treatment strategies for patients with more chronic AN.

Services received and treatment outcomes in day-hospital and residential programs

This longitudinal health services study ( N = 733) (1) examines the impact of services received on 6-month outcomes, and (2) compares day-hospital to residential programs on services received. Services were measured at 2, 4, and 8 weeks postbaseline using a version of the Treatment Services Review. Higher odds of total sobriety at 6 months were associated with greater participation in (a) extracurricular (but not curricular) 12-step meetings, (b) sober recreational events, and (c) educational sessions. Program effects also emerged. Unexpectedly, extracurricular 12-step meeting attendance and the odds of having a sponsor were lower among residential (vs. day hospital) participants through 4 weeks, despite higher participation in curricular 12-step meetings among residential participants at 2 weeks. Still, residential participants reported higher involvement in sober recreation and informal peer socialization across most analyses. Findings suggest that residential and day-hospital programs might maximize outcomes by facilitating optional 12-step involvement and sober recreation, respectively.