ABSTRACT. The need to treat the acute onset of anorexia nervosa in a specialty unit is wel known, but nevertheless, even ''clinically recovered'' patients show a ...
ORIGINAL RESEARCH PAPER
Frequency of recovery from anorexia nervosa of a cohort patients re-evaluated on a long-term basis following intensive care L. Foppiani*, L. Luise**, E. Rasore**, U. Menichini**, and M. Giusti* *DiSEM, Cattedra di Endocrinologia, and **Cattedra di Psichiatria, Università di Genova, Italy
ABSTRACT. The need to treat the acute onset of anorexia nervosa in a specialty unit is wel known, but nevertheless, even ‘’clinically recovered’’ patients show a high rate of relapse. The aim of our study was to re-evaluate various clinical (hemoglobin, transferrin, insulin-like growth factor I, TSH, PRL, gonadotropins and 17β-estradiol) and psychiatric [semistructured interview Eating Disorder Inventory (EDI) Test] parameters in 19 female anorexic patients hospitalized in our department from 1983 to 1993 (with a 9-year median prior to the present study) for the treat ment of anorexia nervosa, and to compare these results with those of a previous follow-up per formed on the same subjects in 1993. In the present evaluation, no significant variation was found among the clinical, nutritional and hormonal parameters when compared to those of the first follow-up in which all parameters had improved with the exception of the PRL levels, which were significantly low. Meanwhile, the percentage of patients with spontaneous menses increased significantly from 50% to 70%, while the number of patients on psychopharmacologi cal therapy decreased significantly throughout the study. Furthermore the percentage o patients with altered (severe or mild) EDI profiles decreased to 50%. This study emphasizes the positive prognostic role of hospitalization and intensive care in a cohort of anorexic patients. The present study, in addition to demonstrating both a general maintenance of body weigh acquired over the years, albeit in the lower normal range, and an increase in the percentage o patients with a regular menstrual cycle, also highlights the persistence of psychiatric abnormali ties in a large number of patients, even in those diagnosed as “clinically recovered”, thus sug gesting the need for long-term psychiatric care. (Eating Weight Disord. 3, 90-94, 1998). ©1998, Editrice Kurtis
INTRODUCTION
Key words: Anorexia nervosa, follow-up, endocrine profile, psychiatric evaluation. Correspondence: Massimo Giusti, M.D., Dipartimento di Scienze Endocrine e Metaboliche (DiSEM), Cattedra di Endocrinologia, Università di Genova, Viale Benedetto XV, 6, 16132 Genova, Italy.
Anorexia nervosa (AN) is a chronic disease whose diagnostic symptoms include a body weight of 15% below the ideal body weight (IBW), an intense fear of gaining weight or becoming fat, even if underweight, amenorrhea, and a disturbance in the way the patient perceives her body weight, size or shape (1). It is well known that AN is a multifactorial disorder, in which biological, endocrine, psychiatric and socio-cultural factors interplay (2). The correct management of the disease is still being debated. Although day-care programs are gaining in increased recognition (3), most patients with significant body weight loss having a Body Mass Index (BMI) less than 17 Kg/m2 must be hospitalized in a specialty unit (4). Long-term followup studies, lasting 10 to 20 years, have shown
that although clinical parameters improve in many patients, psychiatric and behaviora alterations continue to persist (5-8). The aim of this study was to re-evaluate nutritional hormonal and psychiatric parameters in a cohort of anorexic patients hospitalized in the Department of Endocrine and Metabolic Sciences (DISEM), during the past 15 years to compare the results with a follow-up per formed 5 years earlier, and to determine any possible relation between the nutritional and hormonal status and psychopatologica development.
METHODS Subjects and study design From 1983 to 1998, 58 female patients (21.1±0.6 years, ±SD, range 16-34 years) with 90
Follow-up of anorexia nervosa
TABLE 1 Some clinical, nutritional and hormonal parameters of the 19 anorexic patients studied. Weight (Kg)
BMI (Kg/m2)
IBW (%)
T3 (ng/ml)
T4 (ng/ml)
TSH (μUl/ml)
E2 (pg/ml)
IGF1 (ng/ml)
PRL (pg/ml)
Admission
*37.1±1.1
°14.2±0.4
-33.5±1.6(A)
^0.8±0.1
^^^65.3±3.6
1.0±0.1
§14.5±2.0
101.2±13.6(a)
-
Discharge
**41.3±1.0
°°15.9±1.5
-25.6±6.0(B)
-
-
-
-
-
-
1st follow-up
***49.1±2.8
°°°18.9±0.7
-13.5±4.8(C)
^^1.0±0.1
^^^^78.0±4
1.1±0.2
§27.4±6.4
2nd follow-up
48.2±1.6
18.4±0.6
-14.6±4.8
1.1±0.1
77.6±6.9
1.2±0.2
44.3±12.1
**p
