There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .
Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial
BACKGROUND In-patient treatment ( IP ) is the treatment setting of choice for moderately-to-severely ill adolescents with anorexia nervosa , but it is costly , and the risks of relapse and readmissions are high . Day patient treatment ( DP ) is less expensive and might avoid problems of relapse and readmission by easing the transition from hospital to home . We investigated the safety and efficacy of DP after short inpatient care compared with continued IP . METHODS For this multicentre , r and omised , open-label , non-inferiority trial , we enrolled female patients ( aged 11 - 18 years ) with anorexia nervosa from six centres in Germany . Patients were eligible if they had a body-mass index ( BMI ) below the tenth percentile and it was their first admission to hospital for anorexia nervosa . We used a computer-generated r and omisation sequence to r and omly assign patients to continued IP or DP after 3 weeks of inpatient care ( 1:1 ; stratified for age and BMI at admission ) . The treatment programme and treatment intensity in both study groups were identical . The primary outcome was the increase in BMI between the time of admission and a 12-month follow-up adjusted for age and duration of illness ( non-inferiority margin of 0·75 kg/m(2 ) ) . Analysis was done by modified intention to treat . This trial is registered with the International St and ard R and omised Controlled Trial Number Register , number IS RCT N67783402 , and the Deutsches Register Klinischer Studien , number DRKS00000101 . FINDINGS Between Feb 2 , 2007 , to April 27 , 2010 , we screened 660 patients for eligibility , 172 of whom we r and omly allocated to treatment : 85 to IP and 87 to DP . DP was non-inferior to IP with respect to the primary outcome , BMI at the 12-month follow-up ( mean difference 0·46 kg/m(2 ) in favour of DP ( 95 % CI , -0·11 to 1·02 ; pnon-inferiority<0·0001 ) . The number of treatment-related serious adverse events was similar in both study groups ( eight in the IP group , seven in the DP group ) . Three serious adverse events in the IP group and two in the DP group were related to suicidal ideation ; one patient in the DP  attempted suicide 3 months after she was discharged . INTERPRETATION DP after short inpatient care in adolescent patients with non-chronic anorexia nervosa seems no less effective than IP for weight restoration and maintenance during the first year after admission . Thus , DP might be a safe and less costly alternative to IP . Our results justify the broad implementation of this approach . FUNDING German Ministry for Education and Research
There was no superiority of a specific approach .
Weight gains were more rapid in adolescents and inpatient treatment .
Background : The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy .
Weight gain was chosen as the primary outcome criterion .
We also aim ed to compare treatment effects according to service level ( inpatient vs. outpatient ) and age group ( adolescents vs. adults ) .