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| ID | Type | Description | Link |
|---|---|---|---|
| 2023-A02047-38 | Other Identifier | France : Ministry of Health |
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| Name | Class |
|---|---|
| URC-CIC Paris Descartes Necker Cochin | OTHER |
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During the management of chronic illnesses, the day hospital (DH) serves as a brief and effective alternative to traditional hospitalization, offering access to multidisciplinary care. Indeed, patients can benefit from a range of therapeutic tools provided by a multidisciplinary care team while remaining in their living environment. Numerous structures exist for the management of eating disorders, but primarily for severe cases, often following hospitalization, before transitioning to outpatient care. There is no alternative for the initial management of these patients.
The DH for the evaluation and early intervention in recent forms of anorexia nervosa at Maison de Solenn serves as a rapid entry point to specialized care. It allows for a thorough assessment and sustained management of eating disorders. Our hypothesis is that a multidisciplinary, intensive, and early intervention for patients with anorexia nervosa and their families in a day hospital would improve the short, medium, and long-term prognosis of the disease compared to conventional multidisciplinary outpatient care. It would also enhance the family's experience of this pathology and their coping skills.
The patients recruited will come from the active consultation file of the inclusion center (spontaneous consultations, referrals from healthcare professionals, etc.), whether they have had an initial consultation or not. All patients admitted to day hospital during the study period who meet the inclusion criteria will be considered. A first evaluation consultation for mental anorexia will be conducted for all patients, including a somatic and psychological assessment, as well as a consultation with a dietitian. If eligible, the patient and their family will be offered participation in day hospital (for the next session or the following one, depending on availability). In case of refusal, regardless of the reason (parents' availability, excessive distance from home, lack of motivation, etc.), patients will receive regular care in outpatient consultations. For the qualitative study, parents participating in day hospital for their adolescent will be offered inclusion in this research protocol.
The inclusion of young patients will take place over two calendar years (24 consecutive months) for the characterization of the active file. The study will continue for 5 years after the inclusion of the last patient in the study to investigate the outcome. In total, data collection for this research will last a maximum of 84 months (24 months of recruitment and a 5-year follow-up).
Visit 1 - Inclusion: collection of non-oppositions, initial clinical evaluation, then proposal to participate in the day hospital program:
Outpatient follow-up consists of appointments with the psychiatrist, pediatrician, and dietitian, on average, every month.
Follow-up visits:
End of research visit:
- Visit 4 - at 5 years: evaluations, with a search for clinical events
Visits V2, V3, and V4 can be conducted by phone. Visit V4, not necessarily planned as part of the adolescent's follow-up, may be added to care if necessary. It can be conducted by phone, depending on the adolescent's choice.
For participants who have taken part in the day hospital program or outpatient follow-up before the implementation of this protocol and who meet the inclusion criteria, the information sheet will be provided to them during a consultation by an investigator, and non-opposition will be obtained at the next consultation. In case of agreement to participate, data from already conducted visits will be collected retrospectively, and patients will then be contacted for the yet-to-be-performed assessment visits at 6 months (if applicable), 1 year (if applicable), and 5 years.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Day hospital patient | Acceptance of the DH program (DH group): scheduling of 10 to 12 sessions over 12 weeks during a program session, followed by a reassessment at the end of the program. Outpatient follow-up thereafter. |
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| Outpatient | Refusal or inability to participate in the DH program: multidisciplinary follow-up "as usual" within the service (outpatient group). |
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| Parents |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Day Hospital Treatment | Other | Scheduling of 12 half-day sessions per week, alternating between sessions with only the patients or involving the entire family. Close medical monitoring and multidisciplinary interventions during sessions (pediatrician, psychiatrist, dietitian, recovered former patients...). |
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of one or more clinical events | Occurrence of one or more clinical events indicative of the progression of this disease (hospitalization, emergency room visits, major decompensation) at 1 year. Evaluate the impact of early intervention in DH on the clinical progression of the disease compared to the usual outpatient care. | 1 year after inclusion |
| Measure | Description | Time Frame |
|---|---|---|
| Occurrence of one or more clinical events | Occurrence of one or more clinical events indicative of the progression of this disease (hospitalization, emergency room visits, major decompensation) at 5 years in both care groups. Evaluate the long-term impact of early intervention in DH on the clinical progression of the disease, compared to the usual outpatient care. | 5 years after inclusion |
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Inclusion Criteria:
Exclusion Criteria:
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This study will include patients of any gender aged 12 to 18 years and their parents, seen in consultation for anorexia nervosa at the pedopsychiatric unit of the Cochin Hospital, Paris, France.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Corinne BLANCHET, MD, PhD | Contact | 00 33 1 58 41 24 24 | corinne.blanchet@aphp.fr | |
| Marie BENHAMMANI-GODARD | Contact | 00 33 1 58 41 11 90 | marie.godard@aphp.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Maison de Solenn Maison des Adolescents, Cochin Hospital | Recruiting | Paris | IDF | 75014 | France |
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| Multidisciplinary follow-up "as usual" within the service | Other | Multidisciplinary follow-up "as usual" within the service |
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| Conduct semi-structured qualitative interviews | Other | Conduct semi-structured qualitative interviews |
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| Conduct semi-structured qualitative interviews | Conduct semi-structured qualitative interviews with parents after participation in the DH program. Explore the experience and perspectives of families participating in a new day hospital care program for adolescents with recent anorexia nervosa. | After DH termination = 12 weeks after inclusion |
| Satisfaction questionnaire CSQ-8 (Consumer satisfaction questionnaire) | Satisfaction questionnaire at the end of DH care. Assess the satisfaction level of the patient and their parents regarding DH care. The range of possible scores is 8-32; (32 = higher satisfaction = better outcome, 8 = lower satisfaction) | After DH termination = 12 weeks after inclusion |
| Clinical characteristics collection | Initial clinical characteristics at the time of inclusion. Determine predictive factors for the outcome at the end of the intervention and in the long term. | Inclusion |
| Socio-demographic characteristics collection | Initial socio-demographic characteristics at the time of inclusion. Determine predictive factors for the outcome at the end of the intervention and in the long term. | Inclusion |
| Semi-structured interviews (DH program group) | Semi-structured interviews 6 to 12 months after their discharge from day hospital (visit 2 or 3 - DH program group), to assess the impact on the evolution of symptomatology of the experience lived by adolescents in the care within the framework of this early management system for anorexia nervosa (HDJ group). | From 6 to 12 months after the end of day hospital (visit 2 or 3 - DH program group) |
| ID | Term |
|---|---|
| D000856 | Anorexia Nervosa |
| ID | Term |
|---|---|
| D001068 | Feeding and Eating Disorders |
| D001523 | Mental Disorders |
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