Intensive Day Hospital Treatment: How Effective Is It?

Those with binge-purge AN
don’t fare as well as others.

Day hospital treatment is initially effective for most patients; most regain weight and their symptoms are controlled. However, Dr. Marion P. Olmsted and coworkers at Toronto General Hospital Ontario, Canada, wondered how long such benefits may persist after treatment.

As was reported at the Eating Disorders Research Society meeting last October, Dr. Olmsted and four colleagues designed a 12- to 24-month follow-up study to test the effectiveness of day hospital treatment among 175 patients. Fifty-two patients had an anorexia-nervosa-type eating disorder and 123 had a bulimia-nervosa-type disorder; all attended at least one follow-up assessment session. Seventy-eight percent of those who had day hospital treatment participated in the follow-up study.

At the end of treatment, 42% of those with bulimia nervosa (BN)-type disorders were symptom-free, and an additional 55% reported sub-threshold symptoms. By 6 months, 35% of these patients had relapsed, and by 12 months 44% of these had relapsed. Forty-one percent of all those with BN-type disorders remained well throughout the follow-up period.

Of the patients with restrictive-type anorexia nervosa (AN), 65% were weight-restored at the end of treatment, and an additional 24% had a good outcome. Sixty-four percent of these patients maintained their weight over the follow-up period. In contrast, only 22% of patients with binge-purge type AN had a full response at the end of day hospital treatment. An additional 56% had what was described as a moderate response. Fourteen percent remained well over the follow-up period.

For AN patients, the relapse rate was 49% at 6 months and 58% by 12 months after day hospital treatment. Longer-term outcome was relatively good for patients with BN and for those with restricting-type AN. Both long- and short-term outcomes were poor for those with binge-purge type AN.

Dr. Olmsted and colleagues concluded that although day hospital treatment is clearly effective for a large portion of individuals, this is not the case for others, and that a very different approach for these patients-such as those with binge-purge type AN—needs to be developed.