Diversité des prises en charge hospitalières de l’anorexie mentale en psychiatrie en France
L'Encéphale. 2022-10-01; 48(5): 517-529
DOI: 10.1016/j.encep.2021.04.008
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Lasfar M(1), Eveno AL(2), Huas C(3), Godart N(4); EVHAN Group; Members of EVHAN
Group and their individual affiliations.
Collaborators: Godart N(5), Berthoz S(5), Lalanne C(6), Duclos J(7), Mattar
L(5), Roux H(5), Thiébaud MR(5), Vibert S(5), Hubert T(6), Courty A(8),
Ringuenet D(9), Benoit JP(10), Blanchet C(10), Moro MR(10), Bignami L(11),
Nordon C(11), Rouillon F(12), Cook S(13), Doyen C(14), Mouren Siméoni MC(11),
Gerardin P(15), Lebecq S(15), Podlipski MA(15), Gayet C(15), Lasfar M(15),
Delorme M(16), Pommereau X(16), Bioulac S(17), Bouvard M(18), Carrere J(16),
Doncieux K(19), Faucher S(19), Fayollet C(19), Prexl A(19), Billard S(20), Lang
F(20), Mourier-Soleillant V(21), Greiner R(21), Gay A(20), Carrot G(20), Lambert
S(22), Rousselet M(23), Placé L(23), Venisse JL(23), Bronnec M(23), Falissard
B(24), Genolini C(25), Hassler C(24), Tréluyer JM(26), Chacornac O(26), Delattre
M(26), Moulopo N(26), Turuban C(26), Auger C(26).
Author information:
(1)CHU de Rouen, Service de psychopathologie et médecine de l’adolescent, 76000
Rouen, France.
(2)Cabinet médical, 14 ter rue Françoise d’Amboise, 56000 Vannes, France.
(3)Fondation Santé des Étudiants de France, Direction générale, 8, rue E.
Deutsch-de-la-Meurthe, 75014 Paris, France; CESP, Inserm U1018, University
Paris-Sud, Université Paris-Saclay, UVSQ, Villejuif, France.
(4)UFR des Sciences de la Santé Simone Veil (UVSQ), Praticienne Hospitalière,
Fondation Santé des Étudiants de France, Clinique E Rist, 8, rue E.
Deutsch-de-la-Meurthe, 75014 Paris, France. Electronic address:
.
(5)CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 75014
Paris, France; Institut Mutualiste Montsouris, 75014 Paris, France.
(6)Institut Mutualiste Montsouris, 75014 Paris, France.
(7)CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 75014
Paris, France; Institut Mutualiste Montsouris, 75014 Paris, France; University
of Reims, EA 6291, 51097 Reims, France.
(8)CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 75014
Paris, France; Hospital Paul Brousse, AP-HP, 94804 Villejuif, France.
(9)Hospital Paul Brousse, AP-HP, 94804 Villejuif, France.
(10)CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 75014
Paris, France; Maison de Solenn, Hospital Cochin, AP-HP, 75014 Paris, France.
(11)CMME, Saint Anne Hospital, 75014 Paris, France.
(12)CMME, Saint Anne Hospital, 75014 Paris, France; Inserm Center 894, Paris,
75014, France.
(13)Hospital Robert Debré, AP-HP, Paris, 75019, France.
(14)CMME, Saint Anne Hospital, 75014 Paris, France; Hospital Robert Debré,
AP-HP, Paris, 75019, France.
(15)Rouen University Hospital, Department of psychopathology and medicine of
adolescent, 76000 Rouen, France.
(16)University Hospital of Bordeaux, Bordeaux 33077, France.
(17)University Hospital of Bordeaux, Bordeaux 33077, France; USR CNRS 3413
SANPSY, Bordeaux 33077, France.
(18)University Hospital of Bordeaux, Bordeaux 33077, France; University Victor
Segalen Bordeaux 2, Bordeaux 33076 France.
(19)Institut Marcel Rivière, La Verrière, Le Mesnil Saint-Denis 78320, France.
(20)University Hospital of Nord, Saint-Étienne 42055, France; University of
Saint-Étienne, EA 4556 laboratory Epsylon, 42055 France.
(21)University Hospital of Nord, Saint-Étienne 42055, France.
(22)University Hospital of Nantes, Nantes 44300, France.
(23)University Hospital of Nantes, Nantes 44300, France; University of Nantes,
EA 4275, 44300, France.
(24)CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif
94804, France.
(25)UMR 1027, Toulouse 31000, France.
(26)URC-CIC Cochin Necker, AP-HP, Paris 75006, France.
BACKGROUND: Hospitalization is rare in anorexia nervosa (AN) and local
application of indications is heterogeneous. However, no study has evaluated the
effect of these different treatment modalities on the mean length of stay. Our
objective was to describe the context and modalities of a wide range of hospital
care programs offered to patients with anorexia nervosa in eleven specialized
French psychiatric centers for patients from childhood to adulthood. This work
was carried out within the framework of the EVHAN (Evaluation of Hospitalization
for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research
program. The EVHAN program comprises five main lines: weight objectives at
discharge, the practice or not of a separation period, the use of clear
nutritional dietary objectives (cognitive/behavioral), the intensity of family
involvement in treatment, and the existence or absence of a stabilization phase
before ending inpatient treatment. These main lines will make it possible to
study the impact of treatment modalities on the future of patients in the short
and medium term (at discharge and at 1-year follow-up).
METHODS: The eleven centers are located in France (Bordeaux, Nantes, Paris and
Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists,
somatic doctors, nurses, dieticians, psychologists) from each center were
interviewed using a semi-structured questionnaire. Data on operating modalities
and context of care were collected and analyzed.
RESULTS: Four of the eleven centers were exclusively child/adolescent centers,
and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult
centers. All centers offered a graduated approach from outpatient to full
hospitalization. The majority had a number of beds allocated for patients with
eating disorders. The criteria for hospitalization were homogeneous with respect
to somatic and/or psychic severity prefiguring the consensus criteria defined by
the French Health Authority (HAS) in 2010. Child/adolescent units used the
weight curve to set weight objectives at discharge (between the 10th and 50th
percentiles). Most adult units used weight objectives at discharge corresponding
to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral
care contract. One unit did not separate the patient from her/his usual
environment, the others had a practice gradient of partial separation and total
separation times. These were either short, lasting a maximum of 3 weeks, or
long, lasting more than 3 weeks. Conversely, patients were not isolated within
the unit, and benefited from a rich social life, depending on her/his physical
condition. The patient’s family was in contact with the team and fully
supported. The longest periods of separation involved adolescents and adults.
Nutritional support varied from a group approach (meals in the dining room,
standardized meals of the care center) to very individualized approaches within
a specific framework. All the units reported meeting with families at least once
during the hospitalization; with the patient’s parents for child/adolescent
patients and/or unmarried patients and with the husband/wife for married
patients. The majority of the centers requested a phase of weight stabilization,
whatever the age before hospital discharge.
CONCLUSION: There is international and national consensus regarding the
indications for hospitalization, and the main lines of multidisciplinary care to
be developed within this framework. However, local application of these
indications was heterogeneous resulting in diverse modalities of hospital care
for anorexia nervosa in France. Specialized teams have developed management
strategies arising from their « team culture ». The complexity of the anorexic
pathology, due to the psyche-soma intrication and the diversity of age groups,
highlights the complexity of care available. The impact of this diversity of
hospital care on patient outcomes will be studied as a result of this work.
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