Clinical Problems Encountered in the Treatment of Adolescents with Anorexia Nervosa 1Both authors contributed equally.
Abstract
The conceptualization of anorexia nervosa (AN) depends on the diagnostic criteria. Most patients with teenage onset AN seem to remit within 3–10 years depending on the definitions of recovery. The mortality of adolescent onset anorexia nervosa (AN) has fortunately decreased over the last two decades. Based on randomized controlled trials, we review different treatments including individual and group psychotherapy, family therapy, psychopharmacology, and hormone therapy. Treatment settings vary over time for any individual patient. Despite high rates of inpatient treatment, the respective evidence for effectiveness is meager. In underage patients with severe AN clinical, ethical and legal aspects need to be dealt with systematically if intermittent compulsory treatment is deemed necessary. The prolonged and frequently chronic course of AN often entails therapeutic discontinuity; the transition into adulthood requires a graded therapeutic concept that considers the severity of the disorder, developmental and chronological age, and parental involvement. Finally, we consider future clinical and research options to improve treatment and outcome of this eating disorder.
Unser Konzept vom Störungsbild Anorexia nervosa (AN) wird von den diagnostischen Kriterien bestimmt. Die Mehrheit der Patientinnen, die im Jugendalter an AN erkrankt sind, scheint nach Studienlage in Abhängigkeit von der Definition der Remission innerhalb von 3–10 Jahren zu remittieren. Die Mortalität der AN mit Beginn im Jugendalter ist glücklicherweise innerhalb der letzten zwei Dekaden gesunken. Basierend auf randomisiert-kontrollierten Studien stellen wir die verschiedenen Therapieoptionen vor, inklusive Psychotherapie, Psychopharmakologie und Hormontherapie. Das Behandlungssetting variiert bei jeder Patientin über die Zeit; die empirische Evidenz für die längerfristige Überlegenheit einer stationären Therapie ist trotz häufig durchgeführter stationärer Behandlungen als gering anzusehen. Wenn eine zwischenzeitliche Zwangsbehandlung bei minderjährigen Patientinnen mit schwerer AN notwendig erscheint, müssen klinische, ethische und juristische Aspekte systematisch abgewogen werden. Der langwierige und häufig chronische Verlauf der AN hat oft eine Behandlungsdiskontinuität zur Folge. Der Übergang ins Erwachsenenalter erfordert ein gestuftes therapeutisches Konzept, das abhängig ist von der Schwere der Erkrankung, dem Entwicklungs- und chronologischem Alter und der elterlichen Unterstützung. Abschließend beschäftigen wir uns mit zukünftigen notwendigen Forschungsfragen.
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