Recent Progress in the Treatment of Eating Disorders : A New Regimen for the Physical and Psychological Treatment of Patients with Anorexia Nervosa(Progress of Therapy in Eating Disorder)

Abstract

In this paper, we describe a newly developed regimen for the physical and psychological treatment of anorexia nervosa (AN) inpatients at Kyushu University Hospital. Somatic aspects: Both prevention of and treatment for the somatic problems of AN patients who require urgent hospitalization are important. (1) We previously reported that the consumption of energy by patients in a starvation state of BMI>13-14kg/m^2 is by adipolysis and that energy consumption by patients with BMI<13-14kg/m^2 is by protein catabolism. (2) The necessity of urgent hospitalization was associated with the volume of fat free mass, such as muscle, internal organ tissue, and blood. (3) Protein assimilation has priority over fat synthesis when BMI is<12-13kg/m^2. (4) Phosphate-rich beverage (Arginaid^[○!R] intake from the early stage of hospitalization prevents refeeding syndrome in AN patients with BMI<12kg/m^2, even if administered at 30 kcal/kg/day. These findings support the importance of the physical management AN patients with a key BMI of 13kg/m^2. Psychological aspects : AN inpatients are mainly treated with our protocol that we call the "cognitive behavioral approach (CBT) with behavioral limitation." In this integrated approach to the somatic and psychological aspects of AN, the behavioral limitations are lifted step by step as a token for weight gain. In the latter half of our treatment program, we add Naikan therapy for patients who continue to have strong negative feelings about others or who continue to have social and/or family relationship problems. Naikan therapy is combined with CBT to promote introspection. Naikan therapy and "CBT using behavior limitation" are complimentary and promote more effective treatment of AN.