Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Originalarbeit

Die Versorgung von Kindern und Jugendlichen mit Anorexia nervosa in deutschen Kliniken

Published Online:August 21, 2017https://doi.org/10.1024/1422-4917/a000545

Abstract

Zusammenfassung.Fragestellung: Die stationäre Behandlung von Patientinnen mit Anorexia nervosa (AN) wird in Bezug auf ihre mittel- und langfristigen Wirkungen und Nebenwirkungen kontrovers diskutiert. In der deutschen S3-Leitlinie zur Diagnostik und Behandlung der Essstörungen wird die Notwendigkeit eines auf Essstörungen spezialisierten Therapeutenteams betont. Die Versorgung von Kindern und Jugendlichen mit AN in deutschen Kliniken wurde im Hinblick auf aktuelle Diagnostik- und Behandlungskonzepte untersucht. Methodik: Ein Fragebogen wurde an 163 deutsche kinder- und jugendpsychiatrische/-psychosomatische Kliniken versandt, der die Versorgungsstrukturen im Hinblick auf allgemeine Charakteristika der Kliniken sowie Diagnostik und Therapie von Kindern und Jugendlichen mit AN erfasst. Ergebnisse: Alle Kliniken, die Patientinnen mit Essstörungen behandeln (N = 84), bieten Einzeltherapie, familienbasierte Interventionen und Psychoedukation an. Nahezu alle Kliniken definieren ein Zielgewicht. Die angestrebte vorgegebene Gewichtszunahme pro Woche beträgt im Mittel 486 g/Woche (von 200 g bis 700 g/Woche; SD = 117). Alle weiteren diagnostischen und therapeutischen Maßnahmen werden nicht von allen Kliniken durchgeführt. Schlussfolgerungen: In dieser ersten Untersuchung der Versorgungsstrukturen von Kindern und Jugendlichen mit der Diagnose AN in Deutschland konnte gezeigt werden, dass trotz einheitlich integrierter leitliniengerechter Basisbehandlung die Versorgung von Patientinnen mit der Diagnose AN in Bezug auf Diagnostik, Gewichtsrestitution und spezifischer einzel- und gruppentherapeutischer Interventionen deutlich unterschiedlich gehandhabt wird.


The inpatient treatment of patients with anorexia nervosa in German clinics

Abstract.Objective: The medium- and long-term effects and side effects of inpatient treatment of patients with anorexia nervosa is still a matter of debate. The German S3-guidelines underline the importance of providing specialized and competent treatment. In this article we focus on the inpatient service structure in German child and adolescent psychiatric clinics with regard to their diagnostic and therapeutic concepts. Methods: A self-devised questionnaire was sent to 163 German child and adolescent psychiatric clinics. The questionnaire focused on the characteristics of the respective clinic as well as its diagnostic and therapeutic strategies. Results: All clinics with an inpatient service for patients with anorexia nervosa (N = 84) provide single-therapy, family-based interventions and psychoeducation. A target weight is defined in nearly all clinics, and the mean intended weight gain per week is 486 g (range: 200 g to 700 g/week; SD = 117). Certain diagnostic tests and therapeutic interventions are used heterogeneously. Conclusions: This is the first study investigating the inpatient service structure for patients with anorexia nervosa in German clinics. Despite the provision of guideline-based therapy in all clinics, heterogeneous approaches were apparent with respect to specific diagnostic and therapeutic concepts.

Literatur

  • Agostino, H., Erdstein, J. & Di Meglio, G. (2013). Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa. Journal of Adolescent Health, 53(5), 590–594. doi: 10.1016/j.jadohealth.2013.06.005 First citation in articleCrossref Medline, Google Scholar

  • Agras, W. S., Lock, J., Brandt, H., Bryson, S. W., Dodge, E. & Halmi, K. A. et al. (2014). Comparison of 2 family therapies for adolescent anorexia nervosa: a randomized parallel trial. JAMA Psychiatry, 71(11), 1279–1286. doi: 10.1001/jamapsychiatry.2014.1025 First citation in articleGoogle Scholar

  • Dimitropoulos, G., Freeman, V. E., Allemang, B., Couturier, J., McVey, G. & Lock, J. et al. (2015). Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice. Journal of Eating Disorders, 3(1), . doi: 10.1186/s40337-015-0037-3 First citation in articleGoogle Scholar

  • Dimitropoulos, G., Herschman, J., Toulany, A. & Steinegger, C. (2016). A qualitative study on the challenges associated with accepting familial support from the perspective of transition-age youth with eating disorders. Eating Disorders, 24(3), 255–270. doi: 10.1080/10640266.2015.1064276 First citation in articleCrossref Medline, Google Scholar

  • Eisler, I., Simic, M., Hodsoll, J., Asen, E., Berelowitz, M. & Connan, F. et al. (2016). A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry, 16(1), . doi: 10.1186/s12888-016-1129-6 First citation in articleGoogle Scholar

  • Föcker, M., Knoll, S. & Hebebrand, J. (2012). Anorexia nervosa. European Child & Adolescent Psychiatry. doi: 10.1007/s00787-012- 0358-6 First citation in articleMedline, Google Scholar

  • Franko, D. L., Keshaviah, A., Eddy, K. T., Krishna, M., Davis, M. C. & Keel, P. K. et al. (2013). A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa. American Journal of Psychiatry, 170(8), 917–925. doi: 10.1176/appi.ajp.2013.12070868 First citation in articleCrossref Medline, Google Scholar

  • Garber, A. K., Sawyer, S. M., Golden, N. H., Guarda, A. S., Katzman, D. K. & Kohn, M. R. et al. (2016). A systematic review of approaches to refeeding in patients with anorexia nervosa. International Journal of Eating Disorders, 49(3), 293–310. doi: 10. 1002/eat.22482 First citation in articleCrossref Medline, Google Scholar

  • Herpertz, S., Herpertz-Dahlmann, B., Fichter, M. M., Tuschen-Caffier, B. & Zeeck, A. (2010, 12.12.2010). S3 Leitlinie Diagnostik und Behandlung der Essstörungen. Verfügbar unter http://www.awmf.org/uploads/tx_szleitlinien/051-026l_S3_Diagnostik_Therapie_Essstörungen.pdf First citation in articleGoogle Scholar

  • Herpertz-Dahlmann, B., Schwarte, R., Krei, M., Egberts, K., Warnke, A. & Wewetzer, C. et al. (2014). Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet, 383(9924), 1222–1229. doi: 10.1016/S0140-6736(13)62411-3 First citation in articleCrossref Medline, Google Scholar

  • Herpertz-Dahlmann, B., van Elburg, A., Castro-Fornieles, J. & Schmidt, U. (2015). ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosa--a European perspective. European Child & Adolescent Psychiatry, 24(10), 1153–1167. doi: 10.1007/s00787-015-0748-7 First citation in articleCrossref Medline, Google Scholar

  • Heuvel, van den L. L. & Jordaan, G. P. (2014). The psychopharmacological management of eating disorders in children and adolescents. Journal of Child & Adolescent Mental Health, 26(2), 125–137. doi: 10.2989/17280583.2014.909816 First citation in articleGoogle Scholar

  • Jewell, T., Blessitt, E., Stewart, C., Simic, M. & Eisler, I. (2016). Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. Family Process, 55(3), 577–594. doi: 10.1111/famp.12242 First citation in articleCrossref Medline, Google Scholar

  • Knoll, S., Föcker, M. & Hebebrand, J. (2013). Clinical problems encountered in the treatment of adolescents with anorexia nervosa. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 41(6), 433–446. doi: 10.1024/1422-4917/a000259 First citation in articleLink, Google Scholar

  • Kumar, G., Steer, R. A., Teitelman, K. B. & Villacis, L. (2002). Effectiveness of Beck Depression Inventory-II subscales in screening for major depressive disorders in adolescent psychiatric inpatients. Assessment, 9(2), 164–170. First citation in articleCrossref Medline, Google Scholar

  • Le Grange, D., Hughes, e. K., Court, A., Yeo, M., Crosby, R. D. & Sawyer, S. M. (2016). Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 55(8), 683–692. doi: 10.1016/j.jaac.2016.05.007 First citation in articleCrossref Medline, Google Scholar

  • Lindstedt, K., Kjellin, L. & Gustafsson, S. A. (2017). Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample – characteristics and treatment outcome. Journal of Eating Disorders, 5, . doi: 10.1186/s40337-017-0135-5 First citation in articleGoogle Scholar

  • Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W. & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, 67(10), 1025–1032. doi: 10.1001/archgenpsychiatry.2010.128 First citation in articleCrossref Medline, Google Scholar

  • Madden, S., Miskovic-Wheatley, J., Clarke, S., Touyz, S., Hay, P. & Kohn, M. R. (2015). Outcomes of a rapid refeeding protocol in Adolescent Anorexia Nervosa. Journal of Eating Disorders, 3, . doi: 10.1186/s40337-015-0047-1 First citation in articleGoogle Scholar

  • Monge, M. C., Forman, S. F., McKenzie, N. M., Rosen, D. S., Mammel, K. A. & Callahan, S. T. et al. (2015). Use of Psychopharmacologic Medications in Adolescents With Restrictive Eating Disorders: Analysis of Data From the National Eating Disorder Quality Improvement Collaborative. Journal of Adolescent Health, 57(1), 66–72. doi: 10.1016/j.jadohealth.2015.03.021 First citation in articleCrossref Medline, Google Scholar

  • NICE. (2004). http://www.nice.org.uk/nicemedia/live/10932/29218/29218.pdf. Retrieved from http://www.nice.org.uk/nicemedia/live/10932/29218/29218.pdf First citation in articleGoogle Scholar

  • Rocks, T., Pelly, F. & Wilkinson, P. (2014). Nutrition therapy during initiation of refeeding in underweight children and adolescent inpatients with anorexia nervosa: a systematic review of the evidence. Journal of the Academy of Nutrition and Dietetics, 114(6), 897–907. doi: 10.1016/j.jand.2013.11.022 First citation in articleCrossref Medline, Google Scholar

  • Seitz, J., Buhren, K., Biemann, R., Timmesfeld, N., Dempfle, A. & Winter, S. M. et al. (2016). Leptin levels in patients with anorexia nervosa following day/inpatient treatment do not predict weight 1 year post-referral. European Child & Adolescent Psychiatry, 25(9), 1019–1025. doi: 10.1007/s00787-016-0819-4 First citation in articleCrossref Medline, Google Scholar

  • Smink, F. R., van Hoeken, D. & Hoek, H. W. (2012). Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Reports, 14(4), 406–414. doi: 10.1007/s11920- 012-0282-y First citation in articleCrossref Medline, Google Scholar

  • Steinhausen, H. C. (2009). Outcome of eating disorders. Child & Adolescent Psychiatric Clinics of North America, 18(1), 225–242. doi: 10.1016/j.chc.2008.07.013 First citation in articleCrossref Medline, Google Scholar

  • Stiensmeier-Pelster, J., Schürrmann, M. & Duda, K. (2000). Depressions-Inventar für Kinder und Jugendliche (2. Aufl.). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Treasure, J. (2016). Applying evidence-based management to anorexia nervosa. Postgraduate Medical Journal, 92(1091), 525–531. doi: 10.1136/postgradmedj-2015-133282 First citation in articleCrossref Medline, Google Scholar

  • Veronese, N., Solmi, M., Rizza, W., Manzato, E., Sergi, G. & Santonastaso, P. et al. (2015). Vitamin D status in anorexia nervosa: A meta-analysis. International Journal of Eating Disorders, 48(7), 803–813. doi: 10.1002/eat.22370 First citation in articleCrossref Medline, Google Scholar

  • Wieczerkowski, W., Nickel, H., Janowski, A., Fittkau, B. & Rauer, W. (1998). Angstfragebogen für Schüler (AFS). Handanweisung für die Durchführung, Auswertung und Interpretation. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Winston, A. P., Paul, M. & Juanola-Borrat, Y. (2012). The same but different? Treatment of anorexia nervosa in adolescents and adults. European Eating Disorders Review, 20(2), 89–93. doi: 10.1002/erv.1137 First citation in articleCrossref Medline, Google Scholar