Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment.

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043). CONCLUSION: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

Alternativas a la hospitalización total en adolescentes con anorexia nerviosa: Eficacia y características de un nuevo modelo intensivo de tratamiento en hospital de día / Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment

INTRODUCCIÓN: La Hospitalización Total (HT) es el tratamiento de elección para adolescentes con Anorexia Nerviosa (AN) moderada-grave. Sin embargo, ésta es costosa y el riesgo de recaída o reingresos es alto. Una alternativa menos costosa es la Hospitalización Parcial (HP), que puede ayudar a evitar recaídas y reingresos porque facilita la transición del hospital al tratamiento comunitario. OBJETIVO: Evaluar la eficacia de un tratamiento intensivo en HP para adolescentes con AN, el programa de HP para Trastornos de la Conducta Alimentaria (TCA) de 11 horas (HP-TCA-11h), respecto a la recuperación ponderal, evitar ingresos y disminuir estancias en HT. MÉTODO: Se realizó un estudio longitudinal y naturalístico que analizó las variables clínicas y socio-demográficas de los pacientes con AN que fueron dados de alta consecutivamente del HP-TCA-11h, durante los años 2015-2016. RESULTADOS: Se realizaron 77 altas. La edad media fue de 14.4 años (DE: 1.62). La estancia media fue de 28.9 días (DE: 18.5). La media del índice de masa corporal aumentó significativamente al alta (17.2 frente a 17.9, p < 0.001) y a los 12 meses de seguimiento (17.9 frente a 19.3, p < 0.001). Veintinueve (70.8%) pacientes tratados en HP-TCA-11h, que vinieron de un recurso menos intensivo, evitaron el ingreso en HT. Catorce (18.2%) requirieron un reingreso en HP-TCA-11h en dos años. La estancia media en HT disminuyó significativamente (de 33 a 24 días, p < 0.043). CONCLUSIÓN: HP-TCA-11h ha demostrado ser un recurso eficaz como alternativa a la HT para adolescentes con AN moderada-grave. Este nuevo modelo tiene implicaciones coste-efectivas ya que es un recurso seguro y menos costoso que la HT

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with An-orexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alterna-tive to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates tran-sition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP pro-gram for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs.17.9, p < 0.001) and at 12 months fol-low-up (17.9 vs.19.3, p < 0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less inten-sive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p < 0.043). CONCLUSIONS: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moder-ate to severe AN. This new model has cost-effectiveness im-plications as it is a safe resource and is less costly than IT

Dimensional analysis of personality in adolescents with suicidal behavior.

OBJECTIVES: This study is aimed at validating the dimensional internalizing and externalizing approach to personality in a sample of adolescents with suicidal behavior and analyzing the psychopathological and syndromic differences between adolescents from each dimension. METHOD: It is a descriptive and cross-sectional study of 75 adolescents (75% women) who attended the emergency service of a pediatric hospital due to suicidal behavior. Sociodemographic, clinical and psychopathological data and personality profiles (MACI) were gathered. RESULTS: The factorial analysis found two factors (total variance of 77.65%): an internalizing (28% of the cases) and an externalizing profile (72% of the cases). Statistically significant differences were obtained between the two profiles in the expressed concerns and the clinical syndromes of the MACI. CONCLUSIONS: Two differentiated personality profiles were found in our sample of adolescents with suicidal behavior. The externalizing profile was more prevalent. These profiles should guide clinical decisions and help plan therapeutic interventions to reduce the risk of suicidal behavior relapse.

Análisis dimensional de la personalidad del adolescente con conducta suicida / Dimensional analysis of personality in adolescents with suicidal behavior

Objetivos. El presente trabajo tiene por objetivo validar el enfoque bidimensional de personalidad internalizante y externalizante en una muestra de adolescentes con conducta suicida y analizar las diferencias psicopatológicas y sindrómicas entre los adolescentes que tienden a una u otra dimensión. Método. Estudio descriptivo transversal con una muestra de 75 adolescentes (79% chicas) que acudieron a urgencias de un hospital pediátrico por conducta suicida. Se recogieron datos sociodemográficos, clínicos, psicopatológicos y de perfiles de personalidad (MACI). Resultados. El análisis factorial extrajo dos factores (total varianza 77.56%): un perfil internalizante (28% de casos) y otro externalizante (72% de los casos). Se observaron diferencias estadísticamente significativas entre perfiles en preocupaciones expresadas y síndromes clínicos del MACI. Conclusiones. Se obtienen dos perfiles diferenciados de personalidad en la muestra de adolescentes con conducta suicida, siendo el perfil externalizante el más prevalente. Estos perfiles deberían ayudar a tomar decisiones clínicas y planificar intervenciones para reducir el riesgo de repetición de la conducta suicida

Objectives. This study is aimed at validating the dimensional internalizing and externalizing approach to personality in a sample of adolescents with suicidal behavior and analyzing the psychopathological and syndromic differences between adolescents from each dimension. Method. It is a descriptive and cross-sectional study of 75 adolescents (75% women) who attended the emergency service of a pediatric hospital due to suicidal behavior. Sociodemographic, clinical and psychopathological data and personality profiles (MACI) were gathered. Results. The factorial analysis found two factors (total variance of 77.65%): an internalizing (28% of the cases) and an externalizing profile (72% of the cases). Statistically significant differences were obtained between the two profiles in the expressed concerns and the clinical syndromes of the MACI. Conclusions. Two differentiated personality profiles were found in our sample of adolescents with suicidal behavior. The externalizing profile was more prevalent. These profiles should guide clinical decisions and help plan therapeutic interventions to reduce the risk of suicidal behavior relapse