Outcome of bone mineral density in anorexia nervosa patients 11.7 years after first admission.

Osteopenia is a typical finding in patients suffering from anorexia nervosa. Unfortunately, available longitudinal studies are limited by a relatively short follow-up period. Therefore cross-sectional long-term followup studies may help to determine both the outcome of this bone lesion and variables that influence its subsequent development. Of an initial 66 consecutive patients with anorexia nervosa, 51 (77.3%) could be further evaluated. After an average of 11.7 years following first admission, cross-sectional measurements of lumbar and proximal radial bone mineral density (BMD) were performed. The ability to predict BMD using variables obtained from anamnestic and clinical data was then determined by multiple-regression analysis. The BMD of both radial and lumbar bone in anorexic patients with poor disease outcome (as defined by the Morgan-Russell general outcome categories) deviated by -2.18 and -1.73 SD (Z score), respectively. In patients with a good disease outcome lumbar BMD was significantly less reduced compared with radial BMD (-0.26 versus -0.68 SD). Variables reflecting estrogen deficiency and nutritional status in the course of the disease, that is, relative estrogen exposure (for lumbar BMD) and years of anorexia nervosa (for radial BMD), allowed the best prediction of BMD. A marked reduction in cortical and trabecular BMD in anorexic patients with poor disease outcome suggests a higher risk of fractures in these patients. Furthermore, the finding of a persistently reduced cortical and a slightly reduced trabecular BMD, even in patients with good disease outcome, suggests that a recovery of trabecular BMD might be possible, at least in part. Recovery of cortical bone, if possible at all, seems to proceed more slowly.

[Simultaneous diagnosis and simultaneous therapy in a clinical-psychosomatic station]. / Simultandiagnostik und Simultantherapie auf einer klinisch-psychosomatischen Station.

According to modern understanding, bodily, spiritual and social symptoms are seen as the expression of a kind of transmissive disturbance. One could just as well speak of a disturbance in the cybernetic control systems. In this context we understand simultaneous diagnostics and therapy as a proper technique for the understanding and treatment of psychosomatic illnesses. In simultaneous diagnostics and therapy, it is not a matter of adding-up the various symptoms, but rather a matterof an independent method of integrating the various areas. As can be seen in a statistical evaluation of the patients in the clinical psychosomatic station in 1975, a few characteristic tendencies could be traced. By a listing of the frequency of complaints and the correlation with somatic findings, a somatic diagnosis could be found in 60% of the patients. With 36% of the patients no definite connection could be found between the somatic diagnosis, that is the clinical diagnosis, and the main complaints. Besides that, the duration of the symptoms was determined. Important new viewpoints were found in the psychological area in a total of 27 patients and in the somatic area in a total of 19 patients.