Partial Hospitalization for Treatment of Anorexia Nervosa

Due to economic factors, there is pressure to shorten hospital stays for all patients, including those with anorexia nervosa (AN). Patients with AN may be admitted for partial hospitalization, even though it is usually more difficult for them to gain weight in an outpatient setting.

Since normalization of weight is widely used as a criterion for recovery from AN, the cost per pound of weight gained rather than the cost per day of treatment is an important index of the cost-effectiveness of partial hospitalization, according to Angela S. Guarda, MD, of Johns Hopkins Hospital, Baltimore. At the annual meeting of the American Psychiatric Association, Dr. Guarda described the results of a study of partial versus longer-term hospitalization for treatment of a group of 62 anorexic patients. Her hospital’s program includes an integrated step-down, inpatient-partial hospitalization design, with supervised housing, a behavioral protocol, and intensive group therapy.

The average weight gain among the 62 patients studied was more than 2 lb/week. The average cost per pound of weight gained among the patients who were treated initially as inpatients and then transitioned to partial hospitalization was significantly higher than for patients who had inpatient hospitalization. Overt eating disordered eating behavior did not affect inpatient cost per pound gained but did predict lower cost-effectiveness for partial hospitalization. Although partial hospitalization is cost-effective for treating behaviorally compliant AN patients, it is much more cost-effective for severely underweight or behaviorally disruptive patients to remain on an inpatient unit longer before being assigned to partial hospitalization.

Longer-term therapy for AN: more effective

In a second presentation, Arthur L. Robin, PhD, and Patricia Siegel, PhD of Birmingham, MI, reported that short-term therapy had only limited effectiveness among 37 female teens with restricting AN. The girls were assigned to 16 months of Behavioral Family Systems Therapy (BFST) or Ego Oriented Individual Therapy (EOIT). BFST consisted of family sessions focusing on a behavioral-weight gain program, cognitive restructuring, and improved family structure. EOIT included individual adolescent sessions focusing on dynamics that blocked eating; parents were seen separately.

The length of therapy distinctly affected the outcome. For example, 28% of the girls reached their target weights by 6 months, and 68% did so by 16 months. Twenty-eight percent of the girls resumed menstruation by 6 months, and 80% by 16 months. Eating habits, depression, and ego functioning did not improve before 16 months. Psychological variables did not improve until post-assessment follow-up.