Inger Halvorsen

Good outcome of adolescent onset anorexia nervosa after systematic treatment. Intermediate to long-term follow-up of a representative county-sample.

Abstract.We studied the intermediate to long-term outcome of childhood and adolescent onset anorexia nervosa (AN), in a sample that had received systematic treatment based on close cooperation between parents, paediatric department and child and adolescent psychiatry. Of 55 female AN-patients, 51 were examined 3.5–14.5 years after treatment start. The material includes all AN-patients under 18 years in one county that received inpatient treatment and almost all that received outpatient treatment, during the time period 1986–1998.Forty-two (82 %) subjects had no eating disorder (ED) at follow-up, one (2 %) had AN, one (2 %) bulimia nervosa (BN) and seven (14%) had less severe ED (EDNOS). Except the one with BN, none had bulimic symptoms. There was no mortality. Twenty (41%) had one or more other axis-1 psychiatric diagnoses at follow-up. Depression and anxiety disorders were most frequent. Psychosocial functioning assessed by Global Assessment of Functioning (GAF) was fairly good; mean 73±SD14 for symptoms and mean 77±SD13 for functioning. Only 48% were satisfied with life, compared to 83% in a normal population sample. Our conclusion is that the eating disorder outcome was good. However, in accordance with other studies, many subjects had other psychiatric problems at follow-up.

Girls with anorexia nervosa as young adults. Self-reported and parent-reported emotional and behavioural problems compared with siblings.

This follow-up study had three objectives: 1) to investigate emotional and behavioural problems, adaptive functioning and substance use in former anorexia nervosa (AN) patients compared with siblings, 2) to compare information obtained from different informants, and 3) to compare questionnaire results with interview results. Fifty (of 55) female AN patients, representative for AN patients under 18 years referred to county health services, were assessed at a mean of 8.8 years after treatment start with the Young Adult Self-Report and the Young Adult Behaviour Checklist (mean age 23.1 years). In all, 48 patients, 25 siblings, 33 mothers and 27 fathers participated in the questionnaire study. Although 41/50 (82 %) had recovered from their eating disorder, the former AN patients had substantially more self-reported and parent-reported problems than their siblings, particularly with regard to Internalising Problems and on the Anxious/Depressed syndrome scale. Cross-informant agreement between the parents and between parents and patients was high, but low between parents and siblings. The patients with psychiatric diagnoses at follow-up had substantially higher problem scores than those without diagnoses both on the self-report and the parent-report, supporting the validity of the questionnaires. In conclusion, the self- and parent-reports showed a high level of Internalising Problems and were useful instruments in the assessment of former AN patients.

Bone mass eight years after treatment for adolescent-onset anorexia nervosa.

OBJECTIVE This paper aims to study long-term bone mineral development in former patients with an onset of anorexia nervosa during childhood and adolescence. METHODS Bone mineral density (BMD) in lumbar spine and total hip was measured in 39 female participants (mean age = 23.1 years, SD 3.5) an average of 8.1 (±3.3) years after treatment start. RESULTS At follow-up, seven participants (17.9%) still suffered from an eating disorder. Mean BMD in the former patients was within the normal range in the hip but significantly reduced in the spine. Fourteen (36%) of the participants had osteopenia, and three (8%) had osteoporosis in the spine and/or hip. Amenorrhea for more than two years was associated with reduced BMD in the spine, whereas low weight at follow-up was associated with low BMD in both the spine and the hip. CONCLUSION A large minority of these former patients had low bone mass in young adulthood. In accordance with other studies, our findings support the importance of weight restoration for future bone health in young patients with anorexia nervosa.

Rates of weight gain during specialised inpatient treatment for anorexia nervosa

ABSTRACT Background: Guidelines for anorexia nervosa (AN) inpatient treatment suggest weight gain of 0.5–1.0 kg per week, but it is uncertain if this aim is reached in ordinary clinical settings. Aims: To investigate weekly rates of weight gain and associated factors during tertiary AN inpatient treatment. Methods: Data were collected retrospectively from hospital records for all underweight patients admitted to a specialised eating disorders unit from 2007 to 2014. Results: 176 hospital stays (mean duration: 25.4 weeks ± 17.2) were included, of which 96% were females, 31% under 18 years old and 17% received compulsory treatment. Mean body mass index (BMI) increased from 14.8 ± 1.8 to 17.5 ± 2.0, and the mean weekly weight gain was 0.51 ± 0.33 kg the first 11 weeks and 0.18 ± 0.24 kg from week 12 to discharge. Significant predictors of greater weekly weight gain were shorter duration of hospital stay, lower BMI at admission and voluntarily treatment. Conclusion: Although patients’ body weight increased substantially, the rate of weekly weight gain was lower than recommended by guidelines for AN inpatient treatment.

Anorexia in adolescence--healthy in adulthood?

Selective samples The main volume of anorexia research takes place in university hospitals with specialist departments for eating disorders, which tend to have a majority of patients with particularly complicated afflictions. It is therefore uncertain whether the results from these studies are representative of all patients with anorexia. Most children and adolescents with anorexia are treated at inor outpatient mental-health units for young people, often in close cooperation with the paediatric department. Two Swedish follow-up studies of young people with anorexia are exemplary in terms of their long period of follow-up and the representativity of their samples (3, 4). Of 51 adolescents who were diagnosed with anorexia during a screening of eighthgraders in Gothenburg, 13 still suffered from eating disorders ten years later. In the follow-up after 18 years, the number had been reduced to six, whereof three had anorexia. Twenty of these young people had at least one other psychiatric diagnosis, and 13 did not have paid employment because of mental health problems (3). In the other study, 76 adolescents with anorexia, who were treated in psychiatric polyclinics for children and adolescents in Northern Sweden, were followed up after eight and 16 years (4). One person had died before the first follow-up after eight years, and 24 still suffered from anorexia. After 16 years ten patients still had eating disorders, whereof two had anorexia. These results are better than in most comparable studies (1, 2), which could be an effect of the samples being more representative of young people with anorexia.