Diversity of hospital care for anorexia nervosa in psychiatry in France

被引：0

作者：

Lasfar, M. ^{[1
,14
]}

Eveno, A-L ^{[2
]}

Huas, C. ^{[3
,4
]}

Godart, N. ^{[5
,6
,7
]}

Berthoz, S. ^{[6
,7
]}

Lalanne, C. ^{[7
]}

Duclos, J. ^{[6
,7
,8
]}

Mattar, L. ^{[6
,7
]}

Roux, H. ^{[6
,7
]}

Thiebaud, M. R. ^{[6
,7
]}

Vibert, S. ^{[6
,7
]}

Hubert, T. ^{[7
]}

Courty, A. ^{[6
,9
]}

Ringuenet, D. ^{[9
]}

Benoit, J-P ^{[6
,10
]}

Blanchet, C. ^{[6
,10
]}

Moro, M-R ^{[6
,10
]}

Bignami, L. ^{[11
]}

Nordon, C. ^{[11
]}

Rouillon, F. ^{[11
,12
]}

Cook, S. ^{[13
]}

Doyen, C. ^{[11
,13
]}

Simeoni, M-C Mouren ^{[11
]}

Gerardin, P. ^{[14
]}

Lebecq, S. ^{[14
]}

Podlipski, M-A ^{[14
]}

Gayet, C. ^{[14
]}

Delorme, M. ^{[15
]}

Pommereau, X. ^{[15
]}

Bioulac, S. ^{[15
,16
]}

Bouvard, M. ^{[15
,17
]}

Carrere, J. ^{[15
]}

Doncieux, K. ^{[18
]}

Faucher, S. ^{[18
]}

Fayollet, C. ^{[18
]}

Prexl, A. ^{[18
]}

Billard, S. ^{[19
,20
]}

Lang, F. ^{[19
,20
]}

Mourier-Soleillant, V ^{[19
]}

Greiner, R. ^{[19
]}

Gay, A. ^{[19
,20
]}

Carrot, G. ^{[19
,20
]}

Lambert, S. ^{[21
]}

Rousselet, M. ^{[21
,22
]}

Place, L. ^{[21
,22
]}

Venisse, J-L ^{[21
,22
]}

Bronnec, M. ^{[21
,22
]}

Falissard, B. ^{[23
]}

Genolini, C. ^{[24
]}

Hassler, C. ^{[23
]}

机构：

[1] CHU Rouen, Serv Psychopathol & Med Adolescent, F-76000 Rouen, France

[2] Cabinet Med, 14 Ter Rue Francoise dAmboise, F-56000 Vannes, France

[3] Fdn Sante Etudiants France, Direct Gen, 8 Rue E Deutsch de la Meurthe, F-75014 Paris, France

[4] Univ Paris Saclay, UVSQ, Inserm U1018, Univ Paris Sud,CESP, Villejuif, France

[5] UVSQ, UFR Sci Sante Simone Veil, Fdn Sante Etudiants France, Clin E Rist,Praticienne Hosp, 8 Rue E Deutsch de la Meurthe, F-75014 Paris, France

[6] Univ Paris Saclay, Univ Paris Sud, INSERM, CESP,UVSQ, F-75014 Paris, France

[7] Inst Mutualiste Montsouris, F-75014 Paris, France

[8] Univ Reims, EA 6291, F-51097 Reims, France

[9] Hop Paul Brousse, AP HP, F-94804 Villejuif, France

[10] Hosp Cochin, AP HP, Maison Solenn, F-75014 Paris, France

[11] St Anne Hosp, CMME, F-75014 Paris, France

[12] Inserm Ctr 894, F-75014 Paris, France

[13] Hosp Robert Debre, AP HP, F-75019 Paris, France

[14] Rouen Univ Hosp, Dept Psychopathol & Med Adolescent, F-76000 Rouen, France

[15] Univ Hosp Bordeaux, F-33077 Bordeaux, France

[16] USR CNRS 3413 SANPSY, F-33077 Bordeaux, France

[17] Univ Victor Segalen Bordeaux 2, F-33076 Bordeaux, France

[18] Inst Marcel Riviere, F-78320 La Verriere, Le Mesnil Saint, France

[19] Univ Hosp Nord, F-42055 St Etienne, France

[20] Univ Hosp Nantes, EA 4556, Lab Epsylon, F-42055 Nantes, France

[21] Univ Hosp Nantes, F-44300 Nantes, France

[22] Univ Nantes, EA 4275, F-44300 Nantes, France

[23] Univ Paris Sud, UVSQ Univ Paris Saclay, INSERM, CESP, F-94804 Villejuif, France

[24] UMR 1027, F-31000 Toulouse, France

[25] URC CIC Cochin Necker, AP HP, F-75006 Paris, France

来源：

ENCEPHALE-REVUE DE PSYCHIATRIE CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE | 2022年 / 48卷 / 05期

关键词：

Anorexia nervosa; Treatment; Inpatient; CLINICAL-PRACTICE GUIDELINES; INPATIENT TREATMENT; COMORBIDITY; WEIGHT;

D O I：

10.1016/j.encep.2021.04.008

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Background. - Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up).Methods. - The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Etienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed.Results. - Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psy-chic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20 kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care cen-ter) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge.Conclusion. - There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.(c) 2021 L'Encephale, Paris.

引用

页码：517 / 529

页数：13

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