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PubMed2004

Physiological regulation and infantile anorexia: a pilot study.

OBJECTIVE: To examine whether infantile anorexia is associated with physiological dysregulation. METHOD: This study included eight toddlers with infantile anorexia and eight healthy eaters matched for age, race, socioeconomic status, and gender. Physiological measures of heart period and respiratory sinus arrhythmia were assessed across three different situations: mother-toddler interaction, toddler-stranger interaction, and toddler left alone with a toy while mother and stranger talked to each other at the other side of the room. RESULTS: Across all three situations, toddlers with infantile anorexia showed significantly shorter heart periods (i.e., faster heart rates) than controls (p <.05). In addition, as social demand decreased from episode 2 to episode 3, control toddlers exhibited an increase in respiratory sinus arrhythmia, whereas toddlers with infantile anorexia showed a decrease in respiratory sinus arrhythmia (p <.001). CONCLUSIONS: Toddlers with infantile anorexia showed consistently shorter heart periods and were less adaptive in their physiological regulation than controls. Such physiological dysregulation may constitute a tendency for less optimal internal homeostatic regulation of feeding in toddlers with infantile anorexia.

Adaptation, Psychological↗
PubMed2006

Incidence, prevalence and mortality of anorexia nervosa and other eating disorders.

PURPOSE OF REVIEW: The purpose of this review is to evaluate the recent literature on the incidence and prevalence of and mortality associated with eating disorders. RECENT FINDINGS: General-practice studies show that the overall incidence rates of anorexia nervosa remained stable during the 1990s, compared with the 1980s. Some evidence suggests that the occurrence of bulimia nervosa is decreasing. Anorexia nervosa is a common disorder among young white females, but is extremely rare among black females. Recent studies confirm previous findings of the high mortality rate within the anorexia nervosa population. SUMMARY: The incidence of anorexia nervosa is around eight per 100,000 persons per year. An upward trend has been observed in the incidence of anorexia nervosa in the past century till the 1970s. The most substantial increase was among females aged 15-24 years, for whom a significant increase was observed from 1935 to 1999. The average prevalence rates for anorexia nervosa and bulimia nervosa among young females are 0.3 and 1%, respectively. Only a minority of people with eating disorders, especially with bulimia nervosa, are treated in mental healthcare.

Anorexia Nervosa↗
PubMed2004

The endocrine response to acute ghrelin administration is blunted in patients with anorexia nervosa, a ghrelin hypersecretory state.

OBJECTIVE: Ghrelin, a gastric-derived natural ligand of the GH secretagogue (GHS)-receptor (GHS-R), strongly stimulates GH secretion but also possesses other neuroendocrine actions, stimulates food intake and modulates the endocrine pancreas and energy homeostasis. Ghrelin secretion is negatively modulated by food intake. Similarly, glucose and also insulin probably exert an inhibitory effect on ghrelin secretion. Fasting ghrelin levels are reduced in obesity, elevated in anorexia nervosa and restored by weight recovery. The chronic elevation of circulating ghrelin levels in anorexia suggested the hypothesis of an alteration of the sensitivity to the orexigenic action of ghrelin in this condition. The aim of this study was to define the endocrine actions of ghrelin in patients with anorexia nervosa. DESIGN: We enrolled nine women with anorexia nervosa of restricter type [AN; age (mean +/- SEM) 24.2 +/- 1.8 years; body mass index (BMI) 14.7 +/- 0.4 kg/m2] and seven normal young women in their early follicular phase as control group (NW; age 30.6 +/- 3.1 years; BMI 20.3 +/- 0.5 kg/m2). MEASUREMENTS: In all the subjects we studied the GH, PRL, ACTH, cortisol, insulin and glucose responses to acute ghrelin administration (1.0 microg/kg as i.v. bolus). The GH response to GHRH (1.0 microg/kg as i.v. bolus) and basal ghrelin and IGF-I levels were also evaluated in all the subjects. RESULTS: Basal morning ghrelin and GH levels in AN (643.6 +/- 21.3 ng/l and 10.4 +/- 0.5 microg/l, respectively) were higher (P < 0.05) than in NW (233.5 +/- 14.2 ng/l and 0.7 +/- 0.7 microg/l, respectively). However, IGF-I levels in AN (145.3 +/- 10.9 microg/l) were lower (P < 0.05) than in NW (325.4 +/- 12.6 microg/l). The GH response to GHRH in AN was higher (P < 0.05) than that in NW, but in AN the GH response to ghrelin was lower (P < 0.05) than that in NW. In AN and NW ghrelin also induced similar increases (P < 0.05) in PRL, ACTH and cortisol levels. Ghrelin administration was followed by significant increase in glucose levels in NW (P < 0.05) but not in AN. CONCLUSIONS: This study demonstrates that anorexia nervosa, a clinical condition of ghrelin hypersecretion, shows a specific reduction in the GH response to ghrelin, despite the hyper-responsiveness to GHRH administration. The impaired GH response to ghrelin in anorexia nervosa agrees with previous evidence of blunted GH response to synthetic GH secretagogues and could reflect desensitization of the GHS receptor induced by the chronic elevation of ghrelin levels in this pathological state.

Adrenocorticotropic Hormone↗
PubMed2002

Anorexia nervosa: manifestations and management for the gastroenterologist.

Anorexia nervosa is a complex psychiatric disorder with significant morbidity and mortality. It is important for gastroenterologists to be aware of the physiological effects and potential complications of anorexia nervosa, as they are frequently involved in treating patients with this disorder. We review the classic, GI, and neuroendocrinological features of anorexia nervosa. We also discuss gender differences and treatment options in anorexia nervosa. Further studies of GI physiology and pharmacology are needed to determine whether any disturbances may be amenable to therapeutic intervention. Future treatments directed at improving GI sensorimotor function and neurohormonal abnormalities in patients with anorexia nervosa may impact their nutritional rehabilitation and may have important health economic implications as patients avoid hospitalization and are restored to full activities in society. The current team approach, which incorporates psychiatrists, psychologists, nutritionists, pediatricians, internists, and gastroenterologists in the treatment of patients with anorexia nervosa, will continue to be essential.

Anorexia Nervosa↗
PubMed1986

Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa.

UNLABELLED: Gastrointestinal motor function in patients with primary anorexia nervosa has rarely been investigated. We studied oesophageal motor activity in 30 consecutive patients meeting standard diagnostic criteria for primary anorexia nervosa (Feighner et al; DSM III). Seven were found to suffer from achalasia instead of primary anorexia nervosa, one from diffuse oesophageal spasm and one from severe gastro-oesophageal reflux and upper oesophageal sphincter hypertonicity, while partly non-propulsive and repetitive high amplitude, long duration contractions prevailed in the lower oesophagus of another six. In four patients with oesophageal dysmotility not responding to therapy and in 12 of 15 patients with normal oesophageal manometry, gastric emptying of a semisolid meal was studied. Emptying was normal in only three but markedly delayed in 13 cases (half emptying times 97-330 min, median: 147 min, as compared with 21-119 min, median: 47 min, in 24 healthy controls). In eight patients, the effects of domperidone 10 mg iv and placebo were compared under random double blind conditions. Half emptying times were shortened significantly (p less than 0.01) by domperidone. CONCLUSIONS: symptoms of disordered upper gastrointestinal motor activity may be mistaken as indicating primary anorexia nervosa; clinical evaluation of patients with presumed primary anorexia nervosa should rule out the possibility that disordered oesophageal motor activity underlies the symptoms; delayed gastric emptying is a frequent feature in primary anorexia nervosa and might be returned to normal with domperidone.

Adolescent↗
PubMed2006

IL-1beta and LPS induce anorexia by distinct mechanisms differentially dependent on microsomal prostaglandin E synthase-1.

Recent work demonstrated that the febrile response to peripheral immune stimulation with proinflammatory cytokine IL-1beta or bacterial wall lipopolysaccharide (LPS) is mediated by induced synthesis of prostaglandin E(2) by the terminal enzyme microsomal prostaglandin E synthase-1 (mPGES-1). The present study examined whether a similar mechanism might also mediate the anorexia induced by these inflammatory agents. Transgenic mice with a deletion of the Ptges gene, which encodes mPGES-1, and wild-type controls were injected intraperitoneally with IL-1beta, LPS, or saline. Mice were free fed, and food intake was continuously monitored with an automated system for 12 h. Body weight was recorded every 24 h for 4 days. The IL-1beta induced anorexia in wild-type but not knock-out mice, and so it was almost completely dependent on mPGES-1. In contrast, LPS induced anorexia of the same magnitude in both phenotypes, and hence it was independent of mPGES-1. However, when the mice were prestarved for 22 h, LPS induced anorexia and concomitant body weight loss in the knock-out animals that was attenuated compared with the wild-type controls. These data suggest that IL-1beta and LPS induce anorexia by distinct immune-to-brain signaling pathways and that the anorexia induced by LPS is mediated by a mechanism different from the fever induced by LPS. However, nutritional state and/or motivational factors also seem to influence the pathways for immune signaling to the brain. Furthermore, both IL-1beta and LPS caused reduced meal size but not meal frequency, suggesting that both agents exerted an anhedonic effect during these experimental conditions.

Animals↗
PubMedDate not supplied

Abnormalities of the respiratory function and control of ventilation in patients with anorexia nervosa.

BACKGROUND: Anorexia nervosa is a good model to study the effects of malnutrition on the respiratory system, since it excludes the consequences that some chronic diseases can have on the lung. OBJECTIVE: The objective of this study was to assess pulmonary function and alterations in the respiratory system in patients with anorexia nervosa. METHODS: Twenty-two women, 12 with anorexia nervosa and 10 healthy volunteers, were studied. Anthropometric data were gathered for all the participants. In every case, an arterial blood gas test and functional respiratory study, that included spirometry, plethysmography, measure of maximum muscular respiratory pressure and study of the ventilatory pattern at baseline and after hypercapnic stimulation, were performed. RESULTS: No significant differences were found in mean age and height in both groups of patients but there was a difference in body mass index (p < 0.05). In pulmonary function tests, an increase in residual volume (RV), RV/total lung capacity (TLC) ratio and functional residual capacity and a decrease in maximum respiratory pressure were found in patients with anorexia nervosa compared to the control group (p < 0.05). Differences were also found in the ventilatory pattern, with a reduction in minute ventilation and occlusion pressure as well as a decreased response of these parameters to hypercapnic stimulation (p < 0.05) in the patients with anorexia nervosa. CONCLUSION: In patients with anorexia nervosa, a significant elevation in RV, in the RV/TLC ratio and in functional residual capacity and a decrease in the maximum respiratory pressure were noted. In addition, they present an alteration in the central respiratory drive and a response of the respiratory system to hypercapnic stimulation. Although these alterations have no repercussion on the maintenance of gas exchange in baseline conditions, they may have in extreme situations.

Adult↗
PubMed1991

Bone mineral density and anorexia nervosa in women.

OBJECTIVE: A review of reports of reduced bone mineral density in women with anorexia nervosa was undertaken in order to profile specific risk factors, which could then be used as the basis for suggestions for future research and treatment. METHOD: Thirteen research studies and four case studies of reduced bone mineral density and fractures in women with anorexia nervosa were reviewed. The relationships between bone mineral density and amenorrhea, estrogen, calcium intake, physical activity, parathyroid hormone, alkaline phosphatase, 1,25-dihydroxyvitamin D, cortisol, and growth hormone were examined in the reports of these studies and other reports of altered physiology during anorexia nervosa. RESULTS: The average spinal, radial, and femoral bone mineral density in anorexic women was significantly lower than it was in normal control subjects. Concurrent with the low intake of nutrients by individuals with anorexia nervosa, low body weight, early onset and long duration of amenorrhea, low calcium intake, reduced physical activity, and hypercortisolism appeared more likely to contribute to decreased bone mineral density than did other abnormal aspects of the disorder. CONCLUSIONS: Future research needs to address how such factors as amenorrhea and hypercortisolism affect bone mineral density in anorexia nervosa. Since no controlled trials of estrogen replacement or calcium supplementation in anorexia nervosa have been reported, the proper treatment for decreased bone mineral density is not known. However, the most obviously important intervention is to encourage medical stabilization and weight gain.

Adolescent↗
PubMed1996

Anorexia nervosa and bulimia nervosa in alcohol-dependent men and women and their relatives.

OBJECTIVE: Many of the studies linking anorexia nervosa and bulimia nervosa to substance use disorders suffer from problems with small samples; some lack rigorous definitions of the syndromes, and it is difficult to determine whether eating problems were primarily temporary consequences of heavy substance use or drugs were temporarily used in an effort to control appetite. The goal of this study was to evaluate the relationship between alcohol dependence and eating disorders. METHOD: Structured interviews were carried out with 2,283 women and 1,982 men as part of the Collaborative Study on the Genetics of Alcoholism. Data on drug abuse and dependence, psychiatric disorders, and symptoms of anorexia and bulimia were evaluated among alcohol-dependent probands, their relatives, comparison probands, and their relatives. RESULTS: Lifetime rates for anorexia and bulimia were 1.41% and 6.17%, respectively, for the alcohol-dependent women, and bulimia was observed in 1.35% of the alcoholic men. However, once the impact of additional primary diagnoses was controlled for, anorexia was seen in only 1.26% of the women with primary alcohol dependence and none of the alcohol-dependent men; the rates for bulimia were 3.46% and 0.72%, respectively. There was no evidence of a strong familial crossover between alcohol dependence and anorexia or bulimia. CONCLUSIONS: While the rate of anorexia was not elevated in alcoholics after controlling for other disorders, bulimia did occur at a greater than expected rate. However, both eating disorders were relatively rare, and much of the association with alcoholism occurred in the context of additional preexisting or secondary psychiatric disorders.

Adult↗
PubMed1998

Outcome of anorexia nervosa: a case-control study.

OBJECTIVE: Although there have been many studies of the outcome of anorexia nervosa, methodological weaknesses limit their interpretation. The authors used a case-control design to try to improve knowledge about the outcome of anorexia nervosa. METHOD: All new female patients referred to an eating disorders service between Jan. 1, 1981, and Dec. 31, 1984, who had probable or definite anorexia nervosa were eligible for inclusion. Of these women, 86.4% (N = 70) were located and agreed to participate. The comparison group (N = 98) was a random community sample. All subjects were interviewed with a structured diagnostic instrument. RESULTS: A minority of the patients (10%) continued to meet the criteria for anorexia nervosa a mean of 12 years after initial referral. Even among those who no longer met these criteria, relatively low body weight and cognitive features characteristic of anorexia nervosa (perfectionism and cognitive restraint) persisted. The rates of lifetime comorbid major depression, alcohol dependence, and a number of anxiety disorders were very high. CONCLUSIONS: In the managed care/brief treatment era, therapeutic approaches with an excessive focus on weight gain that neglect the detection and treatment of associated psychological features and comorbidity may be inappropriate. Anorexia nervosa is a serious psychiatric disorder with substantial morbidity.

Adolescent↗
PubMed2000

Characteristic regional cerebral blood flow patterns in anorexia nervosa patients with binge/purge behavior.

OBJECTIVE: The authors' goal was to investigate the effect of imagining food on the regional cerebral blood flow (rCBF) of anorexia nervosa patients with and without habitual binge/purge behavior. METHOD: The subjects included seven female patients with purely restrictive anorexia, seven female patients with anorexia and habitual binge/purge behavior, and seven healthy women. Single photon emission computed tomography examination was performed before and after the subjects were asked to imagine food. Changes in rCBF count ratios (percent change) were then calculated and compared. The subjects were also asked to assess their degree of fear regarding their control of food intake. RESULTS: The anorexia nervosa patients with habitual binge/purge behavior had a significantly higher percent change in the inferior, superior, prefrontal, and parietal regions of the right brain than the patients with purely restrictive anorexia and the healthy volunteers. The patients with habitual binge/purge behavior also had the highest level of apprehension in regard to food intake. CONCLUSIONS: Specific activation in cortical regions suggests an association between habitual binge/purge behavior and the food recognition process linked to anxiety in patients with anorexia nervosa.

Adult↗
PubMed2002

D8/17 expression on B lymphocytes in anorexia nervosa.

OBJECTIVE: The authors' goal was to determine whether D8/17, a rheumatic fever susceptibility trait marker, identifies a possible type of anorexia nervosa: pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) anorexia nervosa. METHOD: Using immunofluorescence, the authors measured the percentage of D8/17-positive B lymphocytes in the peripheral blood of 16 subjects 7-21 years old who had not had rheumatic fever but who had possible PANDAS anorexia nervosa. The comparison subjects were 17 psychiatric patients with no eating disorder and no PANDAS characteristics. Subjects were considered D8/17 positive if they had 12% or more D8/17+ cells. RESULTS: There were more D8/17-positive individuals among those with PANDAS anorexia nervosa (81%) than among the comparison subjects (12%). The subjects with PANDAS anorexia nervosa had a higher percentage of D8/17+ cells (mean=27.1%, SD=17%) than the comparison subjects (mean=5.3%, SD=7.4%). CONCLUSIONS: A larger study is needed to determine whether D8/17 serves as a marker for susceptibility to a type of anorexia nervosa.

Adolescent↗
PubMed2003

The intermediate-term outcome of Chinese patients with anorexia nervosa in Hong Kong.

OBJECTIVE: The authors determined the intermediate-term outcome of anorexia nervosa for Chinese patients in Hong Kong. METHOD: A consecutive series of 88 patients who fulfilled DSM-III-R criteria for typical (i.e., fat phobic [N=63]) and atypical (i.e., no fat phobia [N=25]) anorexia nervosa were contacted at least 4 years after onset of their illness for semistructured and self-rated assessments of outcome. RESULTS: Three patients (3.4%) died; the mortality ratio for this group against the expected standard for subjects of similar age and gender was 10.5 to 1. Eighty (94.1%) of the remaining 85 patients were successfully traced 9.0 years after onset of their illness. Good, intermediate, and poor outcomes were seen in 61.8%, 32.9%, and 5.3% of the subjects, respectively. Anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified was exhibited by 55.0% of the subjects (N=44). Lifetime depressive (81.6%) and anxiety (27.6%) disorders were common. Older age at onset and the presence of fat phobia independently predicted poor outcome. Patients with atypical anorexia nervosa were symptomatically stable, less likely to demonstrate bulimia, and had a better eating disorder outcome than patients with typical anorexia nervosa. CONCLUSIONS: The outcome profile of Chinese patients supported the cross-cultural disease validity of anorexia nervosa. The cultural fear of fatness not only shaped the manifest content but also added to the chronicity of the illness.

Adolescent↗
PubMedDate not supplied

Efficacy of voluntary nasogastric tube feeding in female inpatients with anorexia nervosa.

BACKGROUND: This investigation assesses the efficacy of a voluntary nasogastric tube feeding protocol on the weight gain of patients with anorexia nervosa, tube feeding's effect on recovery from the psychologic aspects of anorexia, patient satisfaction with treatment, and medical complications. METHODS: The study included a nonrandomized retrospective review of 381 female inpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of anorexia nervosa, both subtypes. A total of 155 patients received tube feeding and oral refeeding; 226 received oral refeeding alone. Recovery from the psychologic aspects of anorexia was measured by the change in Eating Disorder Inventory-2 scores between admission and discharge. Patient satisfaction with treatment was measured with a patient satisfaction questionnaire completed at discharge. Repeated measures and multivariate analyses were performed. RESULTS: When severity-of-illness and caloric intake differences between patients with and without tube feeding were controlled, patients who received tube feeding gained significantly more weight per treatment week than those who received oral kilocalories alone. Patients who received tube feeding for at least one-half their length of stay gained 1 kg/week versus 0.77 kg/week for patients receiving oral refeeding alone. Tube-fed patients evidenced no differences in recovery from anorexia's psychologic aspects, satisfaction with treatment, or medical complication frequency. CONCLUSIONS: In residential psychiatric treatment settings in which intensive therapeutic interventions and appropriate medical monitoring can manage potential psychologic and medical risks, tube feeding's weight gain benefits may be a viable and safe option in treating anorexia.

Adolescent↗
PubMedDate not supplied

Plasma and erythrocyte amino acid concentrations in anorexia nervosa.

Plasma and erythrocyte amino acid concentrations in seven female patients in the acute stage of anorexia nervosa were compared with values in the same subjects after refeeding, and with normal controls. We also compared these values with literature values from patients with protein-calorie malnutrition and prolonged starvation in an attempt to identify a biological indicator of severity and prognosis. Our data indicate: (1) Routine laboratory analyses that reflect protein status do not differentiate normal subjects from patients with anorexia nervosa. (2) The plasma aminogram in the acute stage of anorexia nervosa differs from normal, and differs from values reported for both protein malnutrition and prolonged starvation. (3) The Whitehead ratio clearly separates the acutely ill anorectic state from the treated state and from normal controls. (4) Both erythrocyte and plasma amino acid concentrations differ from normal in anorexia nervosa, but changes in erythrocyte concentrations are more obvious. (5) Erythrocyte glycine concentrations are unique, in that values were persistently elevated at all stages of illness in anorexia nervosa. (6) Erythrocyte-to-plasma amino acid ratios do not provide a biological index of severity and prognosis for patients with anorexia nervosa, in contrast to data reported for individuals with protein malnutrition.

Adolescent↗
PubMedDate not supplied

The early cancer anorexia paradigm: changes in plasma free tryptophan and feeding indexes.

Tumor growth is accompanied by an anorexia mediated by humoral factors that appear to influence appetitive mechanisms in the brain. Because tumor resection is followed by resumption of normal food intake, the circulating anorexigenic substance(s) are produced either by the neoplastic tissue or by the host in response to the tumor. Increased levels of plasma free tryptophan and plasma ammonia have been proposed to mediate cancer anorexia. With animal models, it is often difficult to ascertain whether changes in food intake depend upon metabolic changes or the progressively increasing tumor mass per se. The feeding patterns and biochemical changes that occur during tumor growth were evaluated in 96 male Fischer rats that were inoculated with 10(6) methylcholanthrene sarcoma cells or saline (controls). Rats were placed into metabolic cages equipped with an Automated Computerized Rat Eater Meter to continuously determine meal size and meal number. Plasma free tryptophan and ammonia were evaluated 6, 10, 16, 18, 22, and 26 days after tumor inoculation. Anorexia developed by day 17-18, when food intake started to decrease via a decrease in meal size but not meal number and reached 60% of control by day 26. However, long before anorexia developed, free tryptophan was significantly higher 6 days after tumor inoculation, and the greatest increase occurred after 18 days. Ammonia did not differ from control at any time. Data confirm tumor-associated increases in plasma free tryptophan that occurred before the manifestation of anorexia and support a possible role of brain serotonin in cancer anorexia.

Ammonia↗
PubMed1999

Difficulties in family functioning and adolescent anorexia nervosa.

BACKGROUND: Difficulties in family functioning are often evident when an adolescent has anorexia nervosa, and the possible causative or contributory role of such difficulties in the illness is unclear. AIMS: To elucidate the relationship between severity of anorexia nervosa and difficulties in family functioning and whether clinical improvement results in diminution of self-rated family difficulties. METHOD: Thirty-five adolescents with anorexia nervosa and their mothers completed the Family Assessment Device (FAD) while clinicians administered the McMaster's Structured Interview of Family Functioning (McSIFF). Severity of anorexia nervosa was rated at baseline and at one year follow-up using the Morgan-Russell Schedule. RESULTS: Clinicians and patients were more critical of the families' functioning than parents. There was an inverse association between the extent of family difficulties and severity of anorexia nervosa. Over time subjects improved clinically but this was not matched by improvement in family functioning. CONCLUSIONS: Difficulties in family functioning do not appear to be directly associated with severity of anorexia nervosa nor do these difficulties reduce with clinical improvement, in the short term.

Adolescent↗
PubMed2006

Outcome and prognostic factors for adolescent female in-patients with anorexia nervosa: 9- to 14-year follow-up.

BACKGROUND: Earlier studies have indicated poor long-term outcomes for patients with anorexia nervosa. AIMS: To study health and social outcomes of adolescent in-patients with anorexia nervosa in relation to prognostic factors. METHOD: A register study based on 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. RESULTS: At 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. CONCLUSIONS: The outcome in this cohort of adolescent in-patients with anorexia nervosa was considerably better than that reported in previous studies.

Adolescent↗