Rückfallprophylaxe bei Anorexia nervosa

 

 Buy Article Permissions and Reprints

Zusammenfassung

Die Anorexia nervosa (AN) ist durch hohe Rückfallraten gekennzeichnet. Therapiekonzepte zur Rückfallprophylaxe, die auf die Aufrechterhaltung der in der Akutbehandlung erreichten Veränderungen ausgerichtet sind, können als eines von mehreren Elementen innerhalb eines integrativen Gesamtbehandlungsplans den Krankheitsverlauf der AN verbessern. Das Behandlungskonzept Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA) von Schmidt & Treasure beinhaltet ein solches Therapieprogramm zur Rückfallprophylaxe, das 5 Phasen umfasst: eine initiale Phase des Veränderungsdialogs und der Motivierung, die Erarbeitung eines individuellen Rückfallmodells, die Förderung kognitiver und sozio-emotionaler Fertigkeiten, die Arbeit an der Identität der Patientin sowie eine abschließende Bilanzierungsphase. Das Therapieprogramm ist auf der Basis des Störungsmodells der AN von Schmidt & Treasure sowie empirischen Befunden zu Risiko- und Schutzfaktoren bezüglich Krankheitsrückfällen entwickelt worden.

Abstract

Anorexia nervosa is characterised by high relapse rates and thus there is a need for strategies that reduce reoccurrence of illness. One way of achieving this is to integrate relapse prevention into treatment, but clearly this requires identification of risk and maintenance factors. The Maudsley Model of Anorexia Nervosa Treatment in Adults (MANTRA) by Schmidt & Treasure has 5 major treatment stages. These include an initial stage of motivation and dialogue about change, an individual relapse formulation, improvement of cognitive and socio-emotional skills, work on the patient’s identity and eventually a final stage of ending and parting. These treatment stages are derived from a maintenance model of AN by Schmidt & Treasure and on evidence from recovered patients and part of their objective is to prevent relapse.

• Literatur

• 1 Zipfel S, Löwe B, Reas DL et al. Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study. Lancet 2000; 355: 721-722
  CrossrefPubMedGoogle Scholar
• 2 Steinhausen H-C. Outcome of eating disorders. Child and Adolescent Psychiatric Clinics of North America 2009; 18: 225-242
  CrossrefPubMedGoogle Scholar
• 3 Carter JC, Blackmore E, Sutandar-Pinnock K et al. Relapse in anorexia nervosa: a survival analysis. Psychological Medicine 2004; 34: 671-679
  CrossrefPubMedGoogle Scholar
• 4 Carter JC, Mercer-Lynn KB, Norwood SJ et al. A prospective study of predictors of relapse in anorexia nervosa: Implications for relapse prevention. Psychiatry Res 2012; 200: 518-523
  CrossrefPubMedGoogle Scholar
• 5 Zepf S, Mengele U, Hartmann S. The state of outpatient psychotherapy in Germany. Psychother Psychosom Med Psychol 2003; 53: 152-162
  Article in Thieme ConnectPubMedGoogle Scholar
• 6 Couturier J, Lock J. What is recovery in adolescent anorexia nervosa?. Int J Eat Disord 2006; 39: 550-555
  CrossrefPubMedGoogle Scholar
• 7 Keel PK, Dorer DJ, Franko DL et al. Postremission predictors of relapse in women with eating disorders. Am J Psychiatry 2005; 162: 2263-2268
  CrossrefPubMedGoogle Scholar
• 8 Steinhausen H-C. The outcome of anorexia nervosa in the 20^th century. Am J Psychiatry 2002; 159: 1284-1293
  Google Scholar
• 9 Federici A, Kaplan AS. The patient’s account of relapse and recovery in anorexia nervosa: a qualitative study. Eur Eat Disord Rev 2008; 16: 1-10
  CrossrefPubMedGoogle Scholar
• 10 Nilsson K, Hagglof B. Patient perspectives of recovery in adolescent onset anorexia nervosa. Eat Disord 2006; 14: 305-311
  CrossrefPubMedGoogle Scholar
• 11 Pettersen G, Rosenvinge JH. Improvement and recovery from eating disorders: a patient perspective. Eat Disord 2002; 10: 61-71
  CrossrefPubMedGoogle Scholar
• 12 Herpertz S, Herpertz-Dahlmann B, Fichter M et al. Hrsg S3-Leitlinie Diagnostik und Behandlung der Essstörungen. Berlin: Springer; 2011
  CrossrefGoogle Scholar
• 13 Giel KE, Groß G, Zipfel S. Neue S3-Leitlinie zur Behandlung von Essstörungen. Verweis auf alte Lücken im deutschen Gesundheitssystem. Psychother Psychosom Med Psychol 2011; 61: 293-294
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Marlatt A, Parks G, Witkiewitz K. Clinical guidelines for implementing relapse prevention therapy. Illinois: The Behavioral Health Recovery Management Project; http://www.bhrm.org/guidelines/RPT%20­guideline.pdf 2002
  Google Scholar
• 15 Mitchell JE, Crosby RD, Wonderlich SA et al. A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav Res Therapy 2008; 46: 581-592
  CrossrefPubMedGoogle Scholar
• 16 Morrow E, Bruce DM, Bruce E et al. Post surgical review of bariatric surgery patients: a feasibility study of multidisciplinary follow up using videoconferencing. Clin Pract Epidemiol Ment Health 2011; 7: 84-88
  CrossrefPubMedGoogle Scholar
• 17 Fichter MM, Quadflieg N, Nisslmuller K et al. Does internet-based prevention reduce the risk of relapse for anorexia nervosa?. Behav Res Ther 2012; 50: 180-190
  CrossrefPubMedGoogle Scholar
• 18 Walsh BT, Kaplan AS, Attia E et al. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. JAMA 2006; 295: 2605-2612
  Google Scholar
• 19 Schmidt U, Treasure J. Anorexia nervosa: Valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Brit J Clin Psychol 2006; 45: 343-366
  CrossrefPubMedGoogle Scholar
• 20 Schmidt U, Oldershaw A, Jichi F et al. Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial. BJP 2012; 201: 392-399
  CrossrefPubMedGoogle Scholar
• 21 Emmelkamp PM. Technological innovations in clinical assessment and psychotherapy. Psychother Psychosom 2005; 74: 336-343
  CrossrefPubMedGoogle Scholar
• 22 Startup H, Sternheim L, Schmidt U. Maudsley Model of Anorexia Nervosa Treatment: Staying Well. Section of Eating Disorders, Institute of Psychiatry, King’s College London Unpublished treatment manual
  PubMedGoogle Scholar
• 23 Miller WR, Rollnick S. Motivational Interviewing. Preparing people for change. New York: Guilford Press; 2002
  Google Scholar
• 24 Seligmann MEP. Flourish: A Visionary New Understanding of Happiness and Well-being. New York: Free Press; 2011
  Google Scholar