0741 Insights into anorexia nervosa

Given the prevalence of conditions such as post-traumatic stress disorder, various forms of depression, and other potentially life-threatening psychiatric disorders it is surprising to note that anorexia nervosa has the highest mortality of all psychiatric disorders. It has a prevalence of ±0.3% in young women, is at least twice as common in teenage girls (average age of onset ±15), and is the commonest cause of weight loss in young women and of admission to child and adolescent hospital services. Average recovery from time of diagnosis is 5-6 years, but up to 30% of patients don’t recover. Overall prognosis appears to be independent of treatment, hospital admission is strongly correlated with poor outcome (if for no other reason than this form of treatment is most likely reserved for the most-affected patients), and outcome is worse (including more deaths) for patients compulsorily admitted than for those who are treated voluntarily. On the other hand, brief periods of hospital admission for treatment of a life-threatening crisis may be associated with lower overall mortality. None of the evidence is particularly strong because there are few randomized controlled studies of groups of anorexics or treatments, however one recent controlled study of 167 subjects randomized to receive in-patient, specialist out-patient or general out-patient treatment in a child and adolescent mental health service showed that each group had made progress at 1 year with further improvement by 2 years. Full recovery was poor within this short time frame (only 33%). Neither in-patient nor specialist out-patient therapy demonstrated advantages over general out-patient care, although several of the latter group required admission on clinical grounds. As previously shown, in-patient care predicted poor outcome. Another report on this same group of patients surprisingly showed that costs over the 2 year period were highest for the general out-patient group (£40794) vs £34531 for in-patient care and £26738 for out-patient care by a specialist. None of this is particularly reassuring for Paediatricians who may be asked for advice by anxious parents, but the best bet in the first instance seems to be referral to an expert for specialist care

Read more:
BMJ 2007; 334: 894-8
Br J Psych 2007; 191: 427-35 and 436-40
Lancet 2001; 357: 1254-7