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
Leitlinien und Empfehlungen für die Praxis

Stationäre Behandlung von Kindern und Jugendlichen mit Anorexia nervosa und Bulimia nervosa

Published Online:September 03, 2019https://doi.org/10.1026/0942-5403/a000294

Abstract

Zusammenfassung. Anorexia nervosa und Bulimia nervosa betreffen vor allem Jugendliche sowie junge Erwachsene, wobei das Ersterkrankungsalter sinkt, und bei Anorexia nervosa bereits 8-Jährige betroffen sein können. Häufig ist der Verlauf chronisch und kann sowohl schwere körperliche als auch psychische Komorbiditäten nach sich ziehen. Schlimmstenfalls enden Essstörungen tödlich (je nach Schweregrad der Erkrankung Mortalitätsraten bis zu 15 % bei Anorexia nervosa). Ein frühzeitiger Therapiebeginn geht mit einer verbesserten Prognose einher, weshalb die rasche Diagnosestellung von großer Bedeutung ist. Wesentlich hierfür ist die sichere Kenntnis der Diagnosekriterien sowie der essstörungstypischen Folgen. Es werden Aspekte der Symptomatik, Diagnostik, Differentialdiagnostik, Epidemiologie, Pathogenese, Funktionalität, sowie Therapiemöglichkeiten und eigene sowie internationale Studienergebnisse mit Schwerpunkt auf der stationären Therapie von Jugendlichen mit Anorexia nervosa und Bulimia nervosa ausgeführt.


Inpatient Treatment of Children and Adolescents With Anorexia nervosa and Bulimia Nervosa

Abstract. Eating disorders (EDs), in particular anorexia nervosa (AN) and bulimia nervosa (BN), mainly affect adolescents and young adults. Studies report a decreasing age of onset of the disorder and even 8-year-old children may be diagnosed with AN. Often, the course of EDs is chronic and associated with both severe comorbid somatic and psychological problems. In the worst case, EDs can be lethal with the mortality rate for AN reaching up to 15 %, depending on the severity of the illness. The etiology of eating disorders is multifactorial. In the pathogenesis, a vulnerability comprising genetic, social, individual, and personality factors interacts with stressful life events and family characteristics. Somatic consequences may be severe, depending on the rate and severity of weight loss in AN and may include, for example, dental damage, gastrointestinal and cardiac problems, as well as decreased bone mineral density followed by pathological fractures. A variety of treatment options exist for young patients with ED, including outpatient, day-clinic, and inpatient treatment. As an early start of therapy is associated with a better prognosis, an early diagnosis of the disorder is of great importance. Knowledge of diagnostic criteria and typical physical and psychological consequences of EDs is essential in this endeavor. The treatment of children and adolescents with EDs should follow the German S3 guideline for the diagnosis and treatment of EDs. The treatment of choice for both AN and BN is psychotherapy. Treatment involving relatives is evidence-based in children and adolescents with EDs and should be an essential part of outpatient or inpatient care. As part of a guideline-oriented therapy, the following therapeutic elements are included: development and normalization of eating behavior and weight, accompanying medical treatment of patients, treatment of possibly existing excessive exercising behavior, description of triggering and sustaining factors of the disorder, improvement of perception and expression of feelings, development of self-esteem, treatment of accompanying psychiatric disorders, preparation of reintegration into family and everyday life, as well as accompanying school care. This article provides an overview of symptomatology, diagnostics, differential diagnostics, epidemiology, pathogenesis, functionality, and treatment options with a focus on inpatient therapy of children and adolescents with AN and BN. Our article ends with a description of previous inpatient studies evaluating the effectiveness of inpatient treatment for adolescents with EDs and a discussion of relapse rates. We also present our own outcome data of inpatient treatment of the adolescent unit of the Schoen Clinic Roseneck.

Literatur

  • Attia, E., Steinglass, J. E., Walsh, B. T., Wang, Y., Wu, P., Schreyer, C. et al. (2019). Olanzapine versus placebo in adult outpatients with anorexia nervosa: A randomized clinical trial. American Journal of Psychiatry [advance online publication] https://doi.org/10.1176/appi.ajp.2018.18101125 First citation in articleCrossref, Google Scholar

  • AWMF (2018). S3-Leitlinie „Diagnostik und Therapie der Essstörungen“. Verfügbar unter: https://www.awmf.org/uploads/tx_szleitlinien/051-026l_S3_Essstoerung-Diagnostik-Therapie_2019-01.pdf. First citation in articleGoogle Scholar

  • Berg, K. C., Crosby, R. D., Cao, L., Peterson, C. B., Engel, S. G., Mitchell, J. E. et al. (2013). Facets of negative affect prior to and following binge-only, purge-only, and binge/purge events in women with bulimia nervosa. Journal of Abnormal Psychology, 122, 111 – 118. First citation in articleCrossref, Google Scholar

  • Bruch, H. (1982). Der goldene Käfig: das Rätsel der Magersucht. Frankfurt: Fischer. First citation in articleGoogle Scholar

  • Calugi, S. & Dalle Grave, R. (2019). Body image concern and treatment outcomes in adolescents with anorexia nervosa. Interational Journal of Eating Disorders [advance online publication] https://doi.org/10.1002/eat.23031 First citation in articleCrossref, Google Scholar

  • Carter, J. C., Mercer-Lynn, K. B., Norwood, S. J., Bewell-Weiss, C. V., Crosby, D., Woodside, D. B. et al. (2012). A prospective study of predictors of relapse in anorexia nervosa: Implications for relapse prevention. Psychiatry Research, 200, 518 – 523. First citation in articleCrossref, Google Scholar

  • Dalle Grave, R., Calugi, S., El Ghoch, M., Conti, M. & Fairburn, C. G. (2014). Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: Immediate and longer-term effects. Frontiers in Psychiatry, 5:14 https://doi.org/10.3389/fpsyt.2014.00014 First citation in articleCrossref, Google Scholar

  • Davis, H. & Attia, E. (2017). Pharmacotherapy of eating disorders. Current Opinion of Psychiatry, 30, 452 – 457. First citation in articleCrossref, Google Scholar

  • Dittmer, N., Voderholzer, U., Mühlen, M. von der, Marwitz, M., Fumi, M., Mönch, C. et al. (2018). Specialized group intervention for compulsive exercise in inpatients with eating disorders: Feasibility and preliminary outcomes. Journal of Eating Disorders, 6:27 https://doi.org/10.1186/s40337-018-0200-8 First citation in articleCrossref, Google Scholar

  • Fennig, S., Brunstein Klomek, A., Shahar, B., Sarel-Michnik, Z. & Hadas, A. (2017). Inpatient treatment has no impact on the core thoughts and perceptions in adolescents with anorexia nervosa. Early Intervention Psychiatry, 11, 200 – 207. First citation in articleCrossref, Google Scholar

  • Goddard, E., Hibbs, R., Raenker, S., Salerno, L., Arcelus, J., Boughton, N. et al. (2013). A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry, 13, 287. First citation in articleGoogle Scholar

  • Greetfeld, M., Cuntz, U. & Voderholzer, U. (2012). Pharmakotherapie von Anorexia nervosa und Bulimia nervosa: State of the Art. Fortschritte Neurologie Psychiatrie, 80, 9 – 16. First citation in articleCrossref, Google 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. First citation in articleCrossref, Google Scholar

  • Himmerich, H. & Treasure, J. (2018). Psychopharmacological advances in eating disorders. Expert Review of Clinical Pharmacology, 11, 95 – 108. First citation in articleCrossref, Google Scholar

  • Hoek, H. W. (2016). Review of the worldwide epidemiology of eating disorders. Current Opinion of Psychiatry, 29, 336 – 339. First citation in articleCrossref, Google Scholar

  • Hubert, T., Pioggiosi, P., Huas, C., Wallier, J., Maria, A. S., Apfel, A. et al. (2013). Drop-out from adolescent and young adult inpatient treatment for anorexia nervosa. Psychiatry Research, 209, 632 – 637. First citation in articleCrossref, Google Scholar

  • Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12 – 19. First citation in articleCrossref, Google Scholar

  • Kanerva, R., Rissanen, A. & Sarna, S. (1995). Fluoxetine in the treatment of anxiety, depressive symptoms, and eating-related symptoms in bulimia nervosa. Nordic Journal of Psychiatry, 49, 237 – 242. First citation in articleCrossref, Google Scholar

  • Keski-Rahkonen, A. & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: Prevalence, incidence, comorbidity, course, consequences, and risk factors. Current Opinion of Psychiatry, 29, 340 – 345. First citation in articleCrossref, Google Scholar

  • Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D. & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5:20 https://doi.org/10.1186/s40337-017-0145-3 First citation in articleCrossref, Google Scholar

  • Legenbauer, T. & Vocks, S. (2014). Manual der kognitiven Verhaltenstherapie bei Anorexie und Bulimie. Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Mekori, E., Halevy, L., Ziv, S. I., Moreno, A., Enoch-Levy, A., Weizman, A. et al. (2017). Predictors of short-term outcome variables in hospitalised female adolescents with eating disorders. International Journal of Psychiatry and Clinical Practice, 21, 41 – 49. First citation in articleCrossref, Google Scholar

  • Morris, J., Simpson, A. V. & Voy, S. J. (2015). Length of stay of inpatients with eating disorders. Clinical Psychology and Psychotherapy, 22, 45 – 53. First citation in articleCrossref, Google Scholar

  • O’Connor, G., Nicholls, D., Hudson, L. & Singhal, A. (2016). Refeeding low weight hospitalized adolescents with anorexia nervosa: A multicenter randomized controlled trial. Nutrition and Clinical Practice, 31, 681 – 689. First citation in articleCrossref, Google Scholar

  • Paul, T. & Thiel, A. (2004). Eating Disorder Inventory-2 (EDI-2): Deutsche Version. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Pettersson, C., Tubic, B., Svedlund, A., Magnusson, P., Ellegard, L., Swolin-Eide, D. et al. (2016). Description of an intensive nutrition therapy in hospitalized adolescents with anorexia nervosa. Eating Behavior, 21, 172 – 178. First citation in articleCrossref, Google Scholar

  • Pudel, V. & Westenhöfer, J. (2003). Ernährungspsychologie: Eine Einführung. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Rohrer, S. & Dietrich, J. W. (2014). Das Refeeding-Syndrom – Eine Literaturübersicht. Zeitschrift für Gastroenterologie, 52, 593 – 600. First citation in articleCrossref, Google Scholar

  • Salbach-Andrae, H., Jacobi, C. & Jaite, C. (2010). Anorexia und Bulimia nervosa im Jugendalter: Kognitiv-verhaltenstherapeutisches Behandlungsmanual. Weinheim: Beltz. First citation in articleGoogle Scholar

  • Salbach-Andrae, H., Schneider, N., Seifert, K., Pfeiffer, E., Lenz, K., Lehmkuhl, U. et al. (2009). Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: A prospective study. European Child and Adolescent Psychiatry, 18, 701 – 704. First citation in articleCrossref, Google Scholar

  • Schlegl, S., Diedrich, A., Neumayr, C., Fumi, M., Naab, S. & Voderholzer, U. (2016). Inpatient treatment for adolescents with anorexia nervosa: Clinical significance and predictors of treatment outcome. European Eating Disorders Review, 24, 214 – 222. First citation in articleCrossref, Google Scholar

  • Steinhausen, H. C. & Seidel, R. (1993). Outcome in adolescent eating disorders. International Journal of Eating Disorders, 14, 487 – 496. First citation in articleCrossref, Google Scholar

  • Strober, M., Freeman, R. & Morrell, W. (1997). The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10 – 15 years in a prospective study. International Journal of Eating Disorders, 22, 339 – 360. First citation in articleCrossref, Google Scholar

  • Vocks, S., Bauer, A. & Legenbauer, T. (2005). Körperbildtherapie bei Anorexia und Bulimia nervosa: Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Voderholzer, U., Naab, S. & Greetfeld, M. (2016). Das sind die Warnsignale einer Anorexia nervosa. MMW Fortschritte der Medizin, 158, 39 – 42. First citation in articleCrossref, Google Scholar