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Mortality May Be Improving in Patients Hospitalized for Anorexia Nervosa

Why? Is it better treatment or earlier detection?

Anorexia nervosa is one of the most lethal disorders in psychiatry, with death rates in female patients higher than in most other female psychiatric patients. Using data from Swedish national registries for hospitalizations and deaths, these investigators compared mortality outcomes of two cohorts: 564 female patients hospitalized for appetite disorder in 1977–1981 (early cohort; mean age 16.4), and 554 female patients hospitalized for anorexia nervosa in 1987–1991 (later cohort; mean age, 15.9).

Each group was followed for 11 years (to 1992 and 2002, respectively). Deaths were recorded in 25 early-cohort patients (4.4%) and in 7 later-cohort patients (1.3%), a hazard mortality ratio of 3.7. Far more deaths occurred during the first months of hospital care in the early cohort than in the later cohort. Six early-cohort patients and one later-cohort patient committed suicide.

Comment: The authors attribute the improvement in overall mortality, mortality during hospitalization, and less-frequent suicide to an array of potential ameliorating factors. During the hospitalization period for the later cohort, Sweden moved treatment of these patients from general-psychiatry units to specialty eating-disorder units. The authors hypothesize that recently improved case detection may have led to earlier hospitalizations and that increased awareness of suicide risk may have contributed to better monitoring and intervention. To test these ideas, researchers should examine comparable data from other countries and communities where anorexia patients continue to be treated primarily in nonspecialty units and by non–eating-disorder specialists. If the authors are correct, a stronger case might be made for treating the disorder in specialty settings.

— Joel Yager, MD

Published in Journal Watch Psychiatry August 21, 2006

Citation(s):

Lindblad F et al. Improved survival in adolescent patients with anorexia nervosa: A comparison of two Swedish national cohorts of female inpatients. Am J Psychiatry 2006 Aug; 163:1433-5.

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