Improvement of Malnutrition in the Initial Treatment for Inpatients with Anorexia Nervosa : On liquid formula therapy

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  • Yamasita Tatsuhisa
    Department of Psychiatry, Kyoto Prefectural University of Medicine
  • Arii Ichiro
    Department of Psychiatry, Kyoto Prefectural University of Medicine:Saisei-kai Suita Hospital
  • Nakamura Michihiko
    Department of Psychiatry, Kyoto Prefectural University of Medicine

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Other Title
  • 入院治療による急性期の栄養状態の改善 : 経口栄養剤療法を中心に(摂食障害に対する治療の最近の進歩)(第37回日本心身医学会総会)
  • 入院治療による急性期の栄養状態の改善--経口栄養剤療法を中心に
  • ニュウイン チリョウ ニヨル キュウセイキ ノ エイヨウ ジョウタイ ノ カイ

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Abstract

It is necessary at first to improve malnutrition as soon as possible, then to introduce psychotherapy dealing with self-identity disturbance in the treatment of patients with anorexia nervosa (AN) . The authors have been using only liquid formula for nutritional rehabilitation in the initial treatment for inpatients with AN (Liquid formula therapy : LFT) . To begin with, the authors presented the first AN case who received LFT in our hospital. In this case, LFT resulted in a) favorable weight gain (4.8 kg/6 weeks) , b) improvement of her ritualistic behavior, c) marked reduction in the meal time, and d) enhancement of motivation for treatment. LFT was thought to be effective to conquer abnormal eating behaviors. Next, the authors compared patients who received LFT (LF group) with patients taking regular hospital meal (RM group) to examine the effects of LFT, and to determine the most suitable AN subtype for LFT. Compared with RM group, LF group showed a) steady increase in calorie intake and body weight, b) more stable defecation that avoided exacerbation of fat phobia due to gastrointestinal discomfort, c) promoted motivation to recovery. The most suitable AN subtype for LFT was found to be the restricting AN patients with long duration of illness. In terms of psychological implications, LFT enacts the separation-individuation process in infancy, and gives psychotherapeutically valuable findings. Finally, we discussed about the problems of LFT. The common obstacles for LFT is patients' resistance to LFT due to their disgust of liquid formula. However, this problem can be solved by therapist's consistent psychoeducatoinal approach. We conclude that LFT is very effective in the initial treatment for inpatients with AN.

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