@phdthesis{Schiffczyk2017,
  author    = {Schiffczyk, Eva-Maria},
  title     = {„Katamnestische Untersuchung der Behandlungszufriedenheit kindlicher Patientinnen und Patienten mit Anorexia nervosa nach station{\"a}rem Klinikaufenthalt"},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-156165},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2017},
  abstract  = {Summary The aims of the current "Catamnestic examination of treatment satisfaction of patients with anorexia nervosa (AN) in childhood after inpatient treatment" were to extend the low data on AN in childhood in general and treatment satisfaction of this patient group in particular, and to use the knowledge gained to optimize future treatment concepts for patients with AN in childhood. To the best of our knowledge this is the first study retrospectively describing the treatment satisfaction of a patient population consisting exclusively of patients with a former AN in childhood. The central questions of the study were to find out whether and how many patients retrospectively found the treatment to be "satisfactory / unsatisfactory" or "helpful / harmful" and which elements of inpatient therapy produced "satisfaction / dissatisfaction" or subjective "help / harm" through the therapy. Further important aims of the study were to find out whether there is a correlation between the "treatment satisfaction / help / treatment amount" and various patient- and therapy-related parameters. The recent catamnestic study shows that former patients with AN in childhood, as well as other groups of AN patients (children, adolescents, adults) in previous studies, appear to be critical about the medical treatment compared to patients with other mental illnesses, with only 55.8 \% of the total patients who were at least mediocrely satisfied showing rather moderate satisfaction rates in the context of closed questions. Most likely are also in patients with AN in childhood typical disease characteristics (e.g. ambivalence in recovery and treatment, fear of loss of control) and personality traits (e.g. rigidity) frequently observed in AN patients responsible for that. The majority of patients with AN in childhood (65.4 \%) considered the therapy to be helpful retrospectively, in accordance with retrospective evaluations of patients with AN (children, adolescents, adults) on treatment as predominantly helpful. As part of the therapy, socio-emotional therapy components such as one-to-one therapeutic sessions, contact with fellow patients and caregivers were of the utmost importance for the patients with AN in childhood. These treatment elements generated the most satisfaction and were considered by many to be the most helpful. The results are hypothesis-generating that childlike patients with AN seem to have a special care / support need in the context of social relationships during therapy. However, the central role of socio-emotional components in therapy has also been highlighted in many other treatment satisfaction studies with childlike / adolescent and adult AN patients, patients with eating disorders in general, child and adolescent psychiatric and general psychiatric patients and in scientific work about the help of therapy for AN patients of different age groups as well as for other patient groups. As part of the therapeutic relationship, the desire for close contact with the therapist (more one-to-one interviews) was expressed. In addition, some patients wanted a more personalized therapy. The therapeutic relationship also played a key role in comparative studies with childlike and adolescent AN patients and other groups of patients, with sufficient time and individualism in therapy being required by the patients. A certain degree of self-determination, a fixed caregiver, inclusion of the family in the therapy, group therapy, adequate feedback and sufficient follow-up care were also important for the patients in the context of treatment. Treatment elements aimed at overcoming eating disordered behavior and recovering from the disease were partly rated to be satisfactory and helpful, but partly unsatisfactory and unhelpful. The critical evaluation of restrictive therapy elements to overcome the symptoms of eating disorders and ambivalence of patients with regard to their willingness to recover, their motivation to change and the initiation and implementation of a treatment, which has been cited in some studies, is also expressed in a group of patients with AN in childhood. With regard to these essential therapeutic ingredients for the treatment of AN, it is probably the right dosage in the context of the therapy concept. A comprehensible correlation was found in the fact that the former childlike AN patients, who judged the treatment to be satisfactory, also perceived it as more helpful and vice versa. The assumption that socio-cultural comparison variables (age and BMI) correlate with treatment satisfaction could not be proven in the own study for the former childlike study collective. Due to very different previous study results, further research on the relationship between socio-demographic variables and patient satisfaction is necessary in order to be able to draw clearer conclusions in this regard. However, an assumed association between the perceived help of the therapy and patient- / therapy-related variables could be confirmed, as patients with higher discharge BMI found treatment to be more helpful retrospectively than those with lower values. From a retrospective patient's perspective, this confirms the currently valid therapeutic guideline for not discharging patients from inpatient treatment until they achieve a body weight appropriate for their age and height (DGPM 2011). In addition, the perceived help from treatment at the different university hospitals showed significant differences, presumably due to the different specialization of the facilities with regard to eating disorders, as previous study results suggest that the treatment in an eating disorder clinic is more helpful than in a non-specialized hospital. With regard to the assessment of the treatment amount, the present catamnestic study showed contradictory results in relation to the long-term (presence of an eating disorder at the time of the catamnestic examination) or short-term treatment result (BMI at discharge) of the former AN patients. On average, patients who rated the amount of treatment as too low reported a higher BMI at hospital discharge (better short-term treatment outcome) than those who judged the treatment amount to be too high. This means that patients with better treatment results in the short term would have wished to receive more treatment quantitatively in the retrospective, than those with worse results. However, in return, more frequently, patients who still had an eating disorder (worse long-term outcome) at the time of study wished to have more treatment quantitatively, than recovered subjects at the time of the study (better long-term outcome). On this basis, it can be hypothesized that the patient group with lower discharge BMI may have had less disease insight than the group with higher discharge BMI, thus less able to engage in therapy with less benefit from it as a result of a poorer treatment outcome. It can also be speculated that in the meantime patients with a still ongoing eating disorder at the time of catamnesis had sufficient insight into the disease and therefore would have wished for more treatment retrospectively. Another plausible result of the current study is that patients who rated the treatment as satisfactory / helpful would have wanted more treatment quantitatively and patients who rated the treatment as unsatisfactory / harmful also judging the treatment amount to be too high. In summary, it becomes clear from our own results that it is a particular challenge to provide a therapy for patients with AN that finds their acceptance and satisfaction (Gulliksen et al., 2012). Accordingly, it is important to refine existing therapies and provide treatments that are adapted to the needs of the patient population. This requires a systematic knowledge of what generates satisfaction and dissatisfaction in patients with AN (Gulliksen et al., 2012). To our knowledge, the present study is the first study on treatment satisfaction that examined exclusively patients with former AN in childhood as a patient collective. Therefore, the results could only be compared with study data from other groups of patients (general psychiatric, child and adolescent psychiatric, eating disorder, adult and adolescent or partly childlike AN patients). Further studies with patients with AN in childhood are useful and desirable to validate the results presented here and to draw practical conclusions for an individualized treatment that meets the needs of the young patients.},
  subject      = {Anorexia nervosa},
  language  = {de}
}