The Impact of Inpatient Weight Restoration in Adoelscent Anorexia Nervosa

This study examines the effect of length of hospital admission for refeeding, prior to manualised outpatient family therapy on outcomes for patients with AN. Subjects will include 72 children and adolescents aged 10 to 18 years admitted for medical management of AN of less than 3 years duration. This study aims to randomly allocate and compare outcomes between individuals with AN admitted for medical stabilisation, approximately 2 to 3 weeks, followed by 20 one hour sessions of outpatient family therapy over a 12 month period versus those admitted for full weight restoration, approximately 9 to 12 weeks also followed by 20 one hour sessions of outpatient family therapy. Physical and psychological outcomes will be measured at admission, at discharge from hospital, completion of outpatient treatment and at 6 and 12 months following outpatient treatment. Medical Compromise Medical compromise will be defined by the presence of one or more of the following: Heart rate of less than 50 beats per minute Blood pressure below 80mm Hg diastolic and 40 systolic mm Hg A postural blood pressure drop of greater than 10mm of Hg The presence of cardiac arrhythmia’s on electrocardiograph A temperature below 35.5 C Electrolyte abnormalities A weight below 75% of predicted IBW Medical Stability Medical stability will be defined as the absence of any of the aforementioned indicators for a period of 72 hours. Minimum Healthy Weight Minimum healthy weight will be defined as reaching 90% of predicted IBW Manualised Family-Based Treatment Family-based treatment will be conducted using a three phase model as defined in “Treatment Manual for Anorexia Nervosa: A Family-Based Approach”. Each family will attend 20 one hour sessions, over a 12 month period. Family-based treatment will commence one week after discharge from hospital. The Maudsley Model of family treatment was developed by Dare and colleagues at the Maudsley hospital in London in the early 1980’s as an out-patient treatment for AN and was subsequently manualised by Lock and colleagues in the United States in 2002. The treatment is of one year duration and consists 20 one hour face to face therapy sessions grouped into three phases. Therapy sessions involve the young person with anorexia nervosa and all members of their family being seen by a family therapist. The model incoorporates aspects of structural and narrative therapy. In the first phase AN is externalised and parents mobilised to refeed their child in the home setting. Parents are seen as a central resource in the process of recovery and notions of familial aetiology are rejected. Siblings are allied with the patient to assist with distress arising as a result of parental control. Phase 1 consists of weekly family thearpy sessions for 12 weeks. Phase two is instigated once the child has reached 90% Ideal Body Weight (IBW) and a transition is made from parental to adolescent control of eating. Sessions during phase 2 are held fortnightly. Once full weight restoration and menstruation is achieved phase three commences which aims to assist the family to restart the normal adolescent life-cycle transition that has been stalled since the onset of the illness. Sessions during phase 3 are held on a monthly basis.