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Átröskunarmeðferð á Íslandi – sjúkdómsmynd, meðferðarheldni og forspárþættir brottfalls

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Authors
Guðrún Mist Gunnarsdóttir
Sigurður Páll Pálsson
Guðlaug Þorsteinsdóttir
Issue Date
2015-05

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Other Titles
Eating Disorder Treatment in Iceland – Treatment adherence, psychiatric co-morbidities and factors influencing drop-out
Citation
Læknablaðið 2015, 101(5):251-7
Abstract
Inngangur: Meðferðarheldni sjúklinga í átröskunarmeðferð hér á landi er óþekkt. Markmið rannsóknar var að kanna brottfallstíðni og finna forspárþætti fyrir meðferðarheldni hjá sjúklingum í átröskunarmeðferð á Landspítala tímabilið 1.9.2008-1.5.2012. Efniviður og aðferðir: Rannsóknin var afturskyggn raunlýsing. Skoð- aðar voru sjúkraskrár sjúklinga sem höfðu fengið tilvísun í meðferð hjá átröskunarteymi Landspítalans og fengið ICD-10 greiningu: lystarstol (F50.0, F50.1), lotugræðgi (F50.2, F50.3) og átröskun ekki nánar skilgreind (ÁENS) (F50.9). Tilvísanir voru 260, 7% mættu ekki í greiningarviðtal og endanlegt úrtak var 182. Brottfall úr meðferð var skilgreint sem ótímabær stöðvun meðferðar án formlegrar útskriftar meðferðaraðila sem mat bata og átröskunarhegðun. Niðurstöður: Úrtakið skiptist í 176 konur og 6 karla, meðalaldur 26,3 ár. Lotugræðgi greindist hjá 52,7% sjúklinga, ÁENS hjá 36,8% og lystarstol hjá 10,4%. Aðra samhliða geðröskun höfðu 74,7% sjúklinga. Kvíða- eða þunglyndisröskun greindist hjá 72,5%, athyglisbrestur og/eða ofvirkni hjá 15,4% og persónuleikaröskun hjá 8,2%. Lífsalgengi fíkniraskana var 30,8%. Brottfall úr meðferð var 54,4% (um 1/3 kom aftur í meðferð á rannsóknartímabilinu), 27,5% sjúklinga luku meðferð og 18,1% sjúklinga voru enn í meðferð þegar eftirfylgnitíma lauk. Meðferðarheldni mældist marktækt betri hjá þeim sjúklingum sem höfðu lokið háskólagráðu, höfðu sjálfir frumkvæði að komu og höfðu meiri kvíða eða þráhyggjueinkenni í greiningarviðtali. Sjúklingar með lystarstol héldust best í meðferð en sjúklingar með fíknigreiningu sýndu meiri tilhneigingu til brottfalls (p=0,079). Ályktun: Heildarbrottfall úr meðferð var svipað og í öðrum rannsóknum en eftirfylgdartími var lengri og sjúklingar með lystarstol héldust betur í meðferð en aðrir sjúklingar með átröskun, öfugt við það sem hefur sést í öðrum vestrænum löndum. Hærra menntunarstig, eigið frumkvæði að meðferð og hærra kvíðaskor á spurningalistum voru verndandi þættir.
Objective: Treatment adherence in patients with eating disorders (ED) in Iceland is unknown. The aim of the study was to investigate treatment drop-out and explore factors that influence premature termination of treatment in a specialized ED treatment unit, at the University Hospital of Iceland, during the period of September 1, 2008 - May 1, 2012. Material and Methods: The study is retrospective and naturalistic. Hospital records of referred patients were examined. Those meeting the ICD 10 criteria of anorexia nervosa (AN) (F50.0, F50.1), bulimia nervosa (BN) (F50.2, F50.3) and eating disorder not otherwise specified (EDNOS) (F50.9) were included. The total sample was 260 and 182 patients met inclusion criteria. No-shows were 7%. Drop-out was defined as premature termination of treatment without formal discharge. Results: The sample consisted of 176 women and 6 men, mean age 26.3 years. BN was diagnosed in 52.7% of patients, EDNOS in 36.8% AN in 10.4%. 74.7% had one or more co-morbid psychiatric diagnosis. Anxiety- and/or depression were diagnosed in 72.5%, Attention hyperactivity deficiency disorder in 15.4% and personality disorders in 8.2%. Lifetime prevalence of substance use disorders (SUDs) was 30.8%. Drop-out from treatment occurred in 54.4% of cases (with approximately 1/3 returning to treatment), 27.5% finished treatment and 18.1% were still in treatment at the end of the follow up period. Treatment adherence was significantly higher in patients who had a university degree, in those who had themselves taken the initiative to seek ED treatment and in those with higher anxiety scores at assessment. AN patients did better than other ED patients while patients with SUDs showed a tendency for higher drop-out (p=0.079). Conclusion: The drop-out rates were similar to what has been reported from other western countries. Follow-up time was longer and AN patient did better than expected. Higher education, initiative in seeking treatment and higher anxiety scores on questionnaires were protective.
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