نتایج طولانی مدت کودکان و نوجوانان با بیماری بی اشتهایی عصبی: مطالعه همبودی

Eighty-seven children and adolescents with anorexia nervosa, admitted to the Gaslini Department of Child Neurology and Psychiatry between 1976 and 1990, were followed up after a mean of 9.6 years. Outcome measures included the Morgan–Russell Outcome Schedule as modified by Jeammet. Outcome was good in 43 (53%) cases, intermediate in 27 (34%) cases, and negative in 11 (14%) cases. No deaths occurred. Based on the Jeammet assessment schedule, the most significant items predicting outcome were insight; sexual, familial, and social relationships; and mental state. Gender of patients and early disease onset did not seem to be predictive measures. Poor outcome was associated with a severe initial clinical picture and length of in-patient treatment. In regard to comorbidity, mood and personality disorders seemed to be negative prognostic indicators, whereas anxiety disorders did not show prognostic value.

Few studies 1 and 2about the outcome of children and adolescents with anorexia nervosa have been reported in the psychiatric literature and little attention has been paid to the problem of comorbidity in this group. To date the most accepted outcome measures of anorexia nervosa are those designed by Morgan and Russell [3]. The assessment of mental state and comorbidity has been performed mainly on adult subjects: studies show a prevalence of mood disorders, obsessive–compulsive disorder, and personality disorders 4, 5 and 6. Recent research 4, 5 and 7has reported obsessive–compulsive disorder or avoidance personality disorder in “restricting” anorexia, borderline personality disorder, or histrionic personality disorder in bulimia or “binge-eating” anorexia. Several reports show a link between eating disorders and mood disorders, particularly major depressive disorder and bipolar disorder 4, 6 and 8. These investigators stressed that there is a reasonable incidence of mood disorders in the families of patients with eating disorders, and underline the efficacy of antidepressive drugs in eating disorders. Following previous research [9]the present study aims to assess outcome and comorbidity in child and adolescent anorexia nervosa.