Management and Outcome in Anorexia Nervosa

1983 ◽  
Vol 143 (3) ◽  
pp. 282-287 ◽  
Author(s):  
H. G. Morgan ◽  
Joan Purgold ◽  
Jill Welbourne
Keyword(s):  
Anorexia Nervosa ◽  
Evaluation Procedure ◽  
Factors Associated ◽  
Poor Outcome ◽  
Duration Of Illness ◽  
Long Duration ◽  
Special Clinic ◽  
Chronic Morbidity

SummaryThe outcome of 78 patients with anorexia nervosa treated in a special clinic is described, using a standardized follow-up technique. The findings are compared with two previous studies which utilized an identical evaluation procedure. Certain predictors of poor outcome already identified by previous studies (long duration of illness before referral, previous personality problems, difficulties in relationship between family and patient) are confirmed. The findings suggest that early intervention may be an important component of effective treatment. The possible advantages of long term continuity of outpatient care are also discussed and the need for careful scrutiny of criteria for hospital admission emphasized.It is concluded that chronic morbidity due to anorexia nervosa represents an important topic for further research. There is need for further identification of factors associated with chronicity, some of which may be secondary repercussions of the illness itself, and prospective evaluation of treatment programmes which focus on predictors of poor outcome.

Family Therapy Outcome in Adolescent Anorexia Nervosa

1993 ◽  
Vol 23 (4) ◽  
pp. 174-179 ◽  
Author(s):  
Daniel le Grange
Keyword(s):  
Anorexia Nervosa ◽  
Family Therapy ◽  
Controlled Trial ◽  
Psychological Treatments ◽  
Duration Of Illness ◽  
Long Term Follow Up ◽  
Adolescent Anorexia Nervosa ◽  
Methods Of Treatment

Anorexia nervosa is a serious psychosomatic illness which often follows a prolonged course. Recent long-term follow-up studies have indicated high mortality rates. It is therefore necessary to search for effective methods of treatment which could improve the outcome in anorexia nervosa. One controlled trial which evaluated the efficacy of different forms of psychological treatments has shown that family therapy is the superior treatment for patients with an early onset and short duration of illness. In this article I review the development of family therapy for anorexia nervosa with specific emphasis on the controlled family treatment studies at the Maudsley Hospital in London. The efficacy of outpatient family therapy for weight restitution in malnourished anorexia nervosa patients, and some effective ingredients of this treatment approach, are discussed.

Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study

2001 ◽  
Vol 31 (5) ◽  
pp. 881-890 ◽  
Author(s):  
B. LÖWE ◽  
S. ZIPFEL ◽  
C. BUCHHOLZ ◽  
Y. DUPONT ◽  
D. L. REAS ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Poor Outcome ◽  
Poor Understanding ◽  
Low Body Mass Index ◽  
Attending Physician ◽  
Standardized Mortality Rate

Background. Given our poor understanding of the very long-term course of anorexia nervosa, many questions remain regarding the potential for recovery and relapse. The purpose of the present study was to investigate long-term outcome and prognosis in an anorexic sample 21 years after the initial treatment.Method. A multidimensional and prospective design was used to assess outcome in 84 patients 9 years after a previous follow-up and 21 years after admission. Among the 70 living patients, the follow-up rate was 90%. Causes of death for the deceased patients were obtained through the attending physician. Predictors of a poor outcome at the 21-year follow-up were selected based on the results of a previous 12-year follow-up of these patients.Results. Fifty-one per cent of the patients were found to be fully recovered at follow-up, 21% were partially recovered and 10% still met full diagnostic criteria for anorexia nervosa. Sixteen per cent were deceased, due to causes related to anorexia nervosa. The standardized mortality rate was 9·8. The three groups also showed significant differences in psychosocial outcome. A low body mass index and a greater severity of social and psychological problems were identified as predictors of a poor outcome.Conclusions. Recovery is still possible for anorexic patients after a period of 21 years. On the other hand, patients can relapse, becoming symptomatic again despite previously achieving recovery status. Only a few patients classified as having a poor outcome were found to seek any form of treatment, therefore, it is recommended that these patients should be monitored regularly and offered treatment whenever possible.

scholarly journals Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 4-year follow-up

2006 ◽  
Vol 189 (5) ◽  
pp. 428-432 ◽  
Author(s):  
Anders Hjern ◽  
Lene Lindberg ◽  
Frank Lindblad
Keyword(s):  
Anorexia Nervosa ◽  
Prognostic Factors ◽  
Hospital Care ◽  
Female Population ◽  
Relative Risks ◽  
Long Duration ◽  
National Cohort ◽  
Financial Dependency

BackgroundEarlier studies have indicated poor long-term outcomes for patients with anorexia nervosa.AimsTo study health and social outcomes of adolescent in-patients with anorexia nervosa in relation to prognostic factors.MethodA register study based on socio-economic and health data was conducted for a national cohort of female residents in Sweden born between 1968 and 1977, including 748 in-patients with anorexia nervosa.ResultsAt follow-up 9–14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7–7.6) and 2.6 (2.3–3.0) respectively compared with the general female population. The mortality rate for patients with anorexia nervosa was 1.2% and the stratified risk ratio for maternity was 0.6 (95% CI 0.5–0.7). Long duration of hospital care and psychiatric comorbidity were predictors of persistent psychiatric problems and financial dependency on society.ConclusionsThe outcome in this cohort of adolescent in-patients with anorexia nervosa was considerably better than that reported in previous studies.

scholarly journals A Low Level of Darunavir Resistance–Associated Mutation Emergence in Patients With Virological Failure During Long-term Use of Darunavir in People With HIV. The ANRS CO3 Aquitaine Cohort

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Hélène Chaussade ◽  
Camille Tumiotto ◽  
Fabien Le Marec ◽  
Olivier Leleux ◽  
Lucile Lefèvre ◽  
...  
Keyword(s):  
Protease Inhibitor ◽  
Virological Failure ◽  
Resistance Test ◽  
Resistance Testing ◽  
Factors Associated ◽  
Viral Loads ◽  
Hiv Resistance ◽  
Baseline Characteristics

Abstract Background Ritonavir-boosted darunavir (DRV/r) is a protease inhibitor (PI) indicated for the treatment of naïve and pretreated HIV-infected patients since 2007. Our study aims to describe DRV/r-treated patients experiencing virological failure (VF) documented with HIV resistance testing. Methods Data from patients belonging to the ANRS CO3 Aquitaine Cohort treated with a regimen including DRV/r between February 2007 and December 2015 were analyzed. Baseline characteristics of patients experiencing VF (defined by 2 consecutive plasma viral loads >50 copies/mL) were compared with those without VF. We then described factors associated with VF as emergence of IAS DRV resistance–associated mutations (RAMs). Results Among the 1458 patients treated at least once with a DRV/r-based regimen, 270 (18.5%) patients experienced VF during follow-up, including 240 with at least 1 genotype resistance test (GRT). DRV RAMs were detected in 29 patients (12%). Among them, 25/29 patients had ≥2 DRV RAMs before DRV/r initiation, all of whom had experienced VF during previous PI treatments. For 18/29, DRV/r was maintained after VF, and controlled viremia was restored after modification of DRV-associated antiretroviral molecules or increased DRV dose. Finally, only 6/29 patients selected new DRV RAMs after DRV/r initiation. All of these experienced previous VFs while on other PIs. Conclusions These results highlight the efficacy and robustness of DRV/r, as the emergence of DRV RAMs appeared in <0.4% of patients receiving a DRV/r-based regimen in our large cohort.

scholarly journals Cancer incidence and factors associated with malignancies in coeliac disease during long‐term follow‐up

GastroHep ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 107-115
Author(s):  
Inka Koskinen ◽  
Kaisa Hervonen ◽  
Eero Pukkala ◽  
Timo Reunala ◽  
Katri Kaukinen ◽  
...  
Keyword(s):  
Coeliac Disease ◽  
Cancer Incidence ◽  
Factors Associated ◽  
Long Term Follow Up

A long term view of myringoplasty in children

1990 ◽  
Vol 104 (10) ◽  
pp. 758-762 ◽  
Author(s):  
J. D. Blanshard ◽  
A. K. Robson ◽  
I. Smith ◽  
A. R. Maw
Keyword(s):  
Success Rate ◽  
Significant Influence ◽  
Hearing Gain ◽  
Graft Take ◽  
Late Failure ◽  
Special Clinic ◽  
Long Term Follow Up

AbstractFifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiologicaloutcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.

ANOREXIA NERVOSA

PEDIATRICS ◽  
1982 ◽  
Vol 70 (4) ◽  
pp. 525-525
Author(s):  
Robert J. Haggerty
Keyword(s):  
Anorexia Nervosa ◽  
Early Onset ◽  
Age Of Onset ◽  
Outcome Studies ◽  
Psychosomatic Disorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Studies

Anorexia nervosa is a serious psychosomatic disorder which most typically begins between 16 and 18 years of age. Clinicians have often held that early onset (eg, ages 11 to 15) is associated with a better outcome. This paper reviews the long-term outcome studies on anorexia nervosa and concludes that this contention is not supported by available data. The methodologies of seven outcome studies that focus on an early onset population are critiqued, and it is concluded that two methodologies are strong. Because of the increasing prevalence of anorexia nervosa, this once rare disorder can now be more easily investigated, and consequently better follow-up studies, which examine potential prognostic factors including age of onset, should be forthcoming.

scholarly journals Long-term outcomes of pediatric arteriovenous malformations: the 30-year Pittsburgh experience

2020 ◽  
Vol 26 (3) ◽  
pp. 275-282
Author(s):  
Michael M. McDowell ◽  
Nitin Agarwal ◽  
Gordon Mao ◽  
Stephen Johnson ◽  
Hideyuki Kano ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Arteriovenous Malformations ◽  
Multimodality Treatment ◽  
Treatment Choice ◽  
University Of Pittsburgh ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
The University

OBJECTIVEThe study of pediatric arteriovenous malformations (pAVMs) is complicated by the rarity of the entity. Treatment choice has often been affected by the availability of different modalities and the experience of the providers present. The University of Pittsburgh experience of multimodality treatment of pAVMs is presented.METHODSThe authors conducted a retrospective cohort study examining 212 patients with pAVM presenting to the University of Pittsburgh between 1988 and 2018, during which patients had access to surgical, endovascular, and radiosurgical options. Univariate analysis was performed comparing good and poor outcomes. A poor outcome was defined as a modified Rankin Scale (mRS) score of ≥ 3. Multivariate analysis via logistic regression was performed on appropriate variables with a p value of ≤ 0.2. Seventy-five percent of the cohort had at least 3 years of follow-up.RESULTSFive patients (2.4%) did not receive any intervention, 131 (61.8%) had GKRS alone, 14 (6.6%) had craniotomies alone, and 2 (0.9%) had embolization alone. Twenty-two (10.4%) had embolization and Gamma Knife radiosurgery (GKRS); 20 (9.4%) had craniotomies and GKRS; 8 (3.8%) had embolization and craniotomies; and 10 (4.7%) had embolization, craniotomies, and GKRS. Thirty-one patients (14.6%) were found to have poor outcome on follow-up. The multivariate analysis performed in patients with poor outcomes was notable for associations with no treatment (OR 18.9, p = 0.02), hemorrhage requiring craniotomy for decompression alone (OR 6, p = 0.03), preoperative mRS score (OR 2.1, p = 0.004), and Spetzler-Martin score (OR 1.8, p = 0.0005). The mean follow-up was 79.7 ± 62.1 months. The confirmed radiographic obliteration rate was 79.4% and there were 5 recurrences found on average 9.5 years after treatment.CONCLUSIONSHigh rates of long-term functional independence (mRS score of ≤ 2) can be achieved with comprehensive multimodality treatment of pAVMs. At this center there was no difference in outcome based on treatment choice when accounting for factors such as Spetzler-Martin grade and presenting morbidity. Recurrences are rare but frequently occur years after treatment, emphasizing the need for long-term screening after obliteration.

scholarly journals Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long term follow up study

BMJ ◽  
1997 ◽  
Vol 314 (7090) ◽  
pp. 1303-1303 ◽  
Author(s):  
C. J Weir ◽  
G. D Murray ◽  
A. G Dyker ◽  
K. R Lees
Keyword(s):  
Acute Stroke ◽  
Independent Predictor ◽  
Follow Up Study ◽  
Poor Outcome ◽  
Long Term Follow Up
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