Abstract
Acceptance of the diagnosis of anorexia nervosa during adolescence and the subsequent treatment of this serious disorder, as well as adherence to the therapeutic recommendations, present significant clinical challenges. This is especially true as the core symptoms of the illness are in direct conflict with the medically necessary goals of gaining weight and normalizing eating behaviors. The path to recovery is in strong opposition to the patient’s obsessional thoughts and restrictive food-related behaviors. This remains a critical matter, given the high mortality rate. Various approaches to engage the adolescent will be discussed in this chapter. We examine the five factors (social and economic factors, healthcare team and system-related factors, condition-related factors, therapy-related factors, and patient-related factors) contributing to nonadherence and offer strategies from our clinical practice and expertise, the literature, as well as some research findings.
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Woodside DB, Carter JC, Blackmore E. Predictors of premature termination of inpatient treatment for anorexia nervosa. Am J Psychiatry. 2004;161(12):2277–82.
Papodopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009;194(1):10–7.
Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, Mitchell JE. Increased mortality in bulimia nervosa and other eating disorders. Am J Psychiatry. 2009;166(12):1342–6.
Fornari V, Kaplan M, Sandberg D, Matthews M, Katz J. The relationship between depression and anxiety disorders in anorexia nervosa and bulimia nervosa. Int J Eat Disord. 1992;12(1):21–9.
World Health Organization (WHO). Adherence to long-term therapies: evidence for action. 2003.; http://www.who.int/chp/knowledge/publications/adherence_report/en/. Accessed 2/5/2018.
American Psychiatric Association. Practice guideline for the treatment of patients with eating disorders, 3rd edition. Am J Psychiatry. 2006;163(suppl):1–54.
Yaeger J, Devlin MJ, Halmi KA, Herzog DB, Mitchell JE, Powers P, Zerbe KJ. Guideline watch (August 2012): practice guideline for the treatment of patients with eating disorders, 3rd edition. APA Executive Committee on Practice Guidelines. APA.
Kafantaris V, Leigh E, Hertz S, Berest A, Schebendach J, Sterling WM, Saito E, Sunday S, Higdon C, Golden NH, Malhotra AK. A placebo-controlled pilot study of adjunctive olanzapine for adolescents with anorexia nervosa. J Child Adolesc Psychopharmacol. 2011;21(3):207–12.
Royal College of Psychiatrists. MARSIPAN: management of really sick patients with anorexia nervosa. 2nd ed; 2014. http://www.rcpsych.ac.uk/publications/collegereports.aspx.
Alanon Pardo MDM, Ferrit Martin M, Calleja Hernandez MA, Morillas Marquez F. Adherence of psychopharmacological prescriptions to clinical practice guidelines in patients with eating behavior disorders. Eur J Clin Pharmacol. 2017;73(10):1305–13.
Bruce KR, Steiger H. Treatment implications of Axis-II comorbidity in eating disorders. Eat Disord. 2005;13(1):93–108.
Bodell LP, Keel PK. Current treatment of anorexia nervosa: efficacy, safety and adherence. Psychol Res Behav Manag. 2010;3:91–108.
Eisler I, Simic M, Russell GF, Aare C. A randomized controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry. 2007;48(6):552–260.
Halmi KA. Perplexities of treatment resistance in eating disorders. BioMed Cent Psychiatry. 2013;13:292.
Steiner H, Mazer D, Litt IF. Compliance and outcome in anorexia nervosa. West J Med. 1990;153(2):133–9.
Towell DB, Woodford S, Reid S, Rooney B, Towell A. Compliance and outcome in treatment-resistant anorexia and bulimia: a retrospective study. Br J Clin Psychol. 2001;40(Pt 2):189–95.
Fornari V, Dancyger U, Schneider M, Fisher M, Goodman B, McCall A. Parental medical in the treatment of adolescents with anorexia nervosa. Int J Eat Disord. 2001;29(3):358–62.
NICE guidance and guidelines. Eating disorders: recognition and treatment. May 2017; National Institute for Health and Care Excellence.
Wilson GT, Shafran R. Eating disorders guidelines from NICE. Lancet. 2005;365(9453):79–81.
Lock J, LeGrange D. Treatment manual for anorexia nervosa: a family-based approach. New York: The Guilford Press; 2015.
Dalle Grave R, Calugi S, El Ghoch M, Conti M, Fairburn CG. Inpatient cognitive behavior therapy for adolescents with anorexia nervosa: immediate and longer-term effects. Front Psychiatry. 2014;5(14):12.
Attia E, Haiman C, Walsh BT, Flater SR. Does fluoxetine augment the inpatient treatment of anorexia nervosa? Am J Psychiatry. 1998;155(4):548–51.
Biederman J, Herzog DB, Rivinus TM, et al. Amitriptyline in the treatment of anorexia nervosa: a double-blind, placebo-controlled study. J Clin Psychopharmacol. 1985;5(1):10–6.
Moskowitz LJ, Ku B, Shadianloo S, Fornari VM. Psychopharmacology in the treatment of eating disorders. Adolesc Med (AMSTAR). 2018;029:384–403.
Wade TD, Frayne A, Edward SA, Robertson T, Gilchrist P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Aust N Z J Psychiatry. 2009;43(3):235–43.
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Fornari, V., Dancyger, I. (2019). Coming of Age and Refusing to Eat: Overcoming Treatment Nonadherence for Adolescents with Anorexia Nervosa. In: Fornari, V., Dancyger, I. (eds) Psychiatric Nonadherence. Springer, Cham. https://doi.org/10.1007/978-3-030-12665-0_3
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