Eating Disorders - Aspects of Treatment and Outcome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults.
The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression.
In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death.
A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation.
The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.
Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 916
Anorexia Nervosa, Eating Disorders, Mortality, Standard Mortality Ratio, Adolescent, Family-Based Treatment, Out-patient, Olanzapine, Omega-3
Research subject Child and Youth Psychiatry
IdentifiersURN: urn:nbn:se:uu:diva-204209ISBN: 978-91-554-8706-5OAI: oai:DiVA.org:uu-204209DiVA: diva2:638154
2013-09-12, Rudbeck salen, Rudbeckslaboratoriet, ing. C, bv, Dag Hammarskjöldsväg 20, Uppsala, 09:15 (Swedish)
Wentz, Elisabet, associate professor
Swenne, Ingemar, associate professor
List of papers