People with anorexia nervosa at increased risk for relapse soon after acute care discharge

Adults with anorexia nervosa had increased risk for relapse in the first months after acute care discharge, according to study results published in American Journal of Psychiatry.

“To our knowledge, only two previous studies have examined the rate of relapse over time in anorexia nervosa, and neither of them was able to identify an inflection point as suggested by [authors of a landmark paper on stages of major depression],” B. Timothy Walsh, MD, of the department of psychiatry at Columbia University Irving Medical Center in New York, and colleagues wrote. “In the present analysis, we examined data from a previously published study regarding relapse in anorexia nervosa to determine whether a point of rarity could be identified after which the risk of relapse changed, thereby suggesting a criterion for the duration of remission after which the individual could be considered recovered. Identification of such a point of rarity would be of potential clinical utility in helping to judge the need for and intensity of ongoing treatment.”

In the prior study, researchers randomly assigned 93 women with anorexia nervosa to either fluoxetine or placebo after weight restoration in an acute care setting. Participants were discharged to outpatient care, where they received cognitive behavioral therapy for 1 year or less. The researchers defined relapse according to a priori clinical criteria and noted fluoxetine did not affect the time to relapse.

In the present analysis, Walsh and colleagues calculated the risk for relapse over the following 60 days and the following 90 days for each day after entry into the study. They fitted a parametric function to approximate the Kaplan-Meier estimator. Results showed an immediate increase in the risk for relapse after entry into the study, which peaked after approximately 60 days and then gradually declined. The researchers did not observe evidence of an inflection point at which the risk for relapse fell significantly after the initial peak.

“Although it may be useful for administrative or research-oriented reasons to declare that patients with anorexia nervosa have recovered after they have been symptom free for a specified length of time, it should be recognized that such an interval must be chosen somewhat arbitrarily, as no specific length of time is suggested by the currently available empirical evidence,” Walsh and colleagues wrote.