Management of anorexia nervosa revisited
http://www.100md.com
《英国医生杂志》
EDITOR—I agree with Berelowitz that outpatient treatment is no less deserving of adequate funding than inpatient—particularly as most patients spend considerably more time as outpatients. Certainly Gowers is a cogent detractor of inpatient care in adolescent anorexia nervosa, and despite his generalisations about quality of inpatient settings, in principle, I have no argument with his assertion.1
Ideally, outpatient family therapy and medical support should be preferable. However, in our experience this is not always the case for various reasons. A specialised medical psychiatric inpatient programme with suitable milieu would be expected to manage eating disorders better than could a general paediatric or adolescent medical setting, and preliminary evaluation of our own programme supports this contention.2 I plead for provision of an appropriate level of specialist care, both inpatient and outpatient, as many patients require both.
I emphasise that I was simply suggesting on the basis of molecular genetic data (as sound as any available) that noradrenergic agents should be considered in treating depressed patients with anorexia nervosa (restrictive subtype).3 4 Our studies were not supported by a drug company. We found good responses with the addition of reboxetine to a selective serotonin reuptake inhibitor and to venlafaxine when there has been little or no response to selective serotonin reuptake inhibitors alone.
Janice Russell, clinical associate professor and medical director
Eating Disorders Program, Northside Clinic, Greenwich, NSW 2065, Australia jrussel1@mail.usyd.edu.au
Competing interests: JR is also the director of a privately funded multidisciplinary eating disorders clinic.
References
Gowers S, Weetman J, Shore A, Hossain F, Elvins R. Impact of hospitalisation on the outcome of adolescent anorexia nervosa. Br J Psychiatry 2000;176: 138-41.
Russell JD, Abraham SF. Evolving evidence and continuing uncertainties for eating disorders. Med J Austr 2002;176: 299-300.
Urwin R, Bennetts B, Wilcken B, Beumont P, Clarke S, Russell J, et al. Anorexia nervosa (restrictive subtype) is associated with polymorphism in the novel norepinephrine transporter gene promoter polymorphic region. Mol Psychiatry 2002;7: 652-7.
Urwin RE, Bennetts B, Wilcken B, Beumont PJV, Russell JD, Nunn KP. Investigation of epistasis between the serotonin transporter and norepinephrine transporter genes in anorexia nervosa. Neuropsychopharmacology 2003;28: 1351-5.
Ideally, outpatient family therapy and medical support should be preferable. However, in our experience this is not always the case for various reasons. A specialised medical psychiatric inpatient programme with suitable milieu would be expected to manage eating disorders better than could a general paediatric or adolescent medical setting, and preliminary evaluation of our own programme supports this contention.2 I plead for provision of an appropriate level of specialist care, both inpatient and outpatient, as many patients require both.
I emphasise that I was simply suggesting on the basis of molecular genetic data (as sound as any available) that noradrenergic agents should be considered in treating depressed patients with anorexia nervosa (restrictive subtype).3 4 Our studies were not supported by a drug company. We found good responses with the addition of reboxetine to a selective serotonin reuptake inhibitor and to venlafaxine when there has been little or no response to selective serotonin reuptake inhibitors alone.
Janice Russell, clinical associate professor and medical director
Eating Disorders Program, Northside Clinic, Greenwich, NSW 2065, Australia jrussel1@mail.usyd.edu.au
Competing interests: JR is also the director of a privately funded multidisciplinary eating disorders clinic.
References
Gowers S, Weetman J, Shore A, Hossain F, Elvins R. Impact of hospitalisation on the outcome of adolescent anorexia nervosa. Br J Psychiatry 2000;176: 138-41.
Russell JD, Abraham SF. Evolving evidence and continuing uncertainties for eating disorders. Med J Austr 2002;176: 299-300.
Urwin R, Bennetts B, Wilcken B, Beumont P, Clarke S, Russell J, et al. Anorexia nervosa (restrictive subtype) is associated with polymorphism in the novel norepinephrine transporter gene promoter polymorphic region. Mol Psychiatry 2002;7: 652-7.
Urwin RE, Bennetts B, Wilcken B, Beumont PJV, Russell JD, Nunn KP. Investigation of epistasis between the serotonin transporter and norepinephrine transporter genes in anorexia nervosa. Neuropsychopharmacology 2003;28: 1351-5.