Help for Patients Who Just Can’t Recover

Courtesy of Eating Disorders Review

A Swedish study applies the case management approach for enduring eating disorders.

Some patients with severe eating disorders just don’t get better despite long-term treatment, and may go on to develop severe and enduring eating disorders (SEED). An eating disorders center in Stockholm is currently testing a case management system to help such patients (J Eat Disord. 2016; 4:24).

In 2014, the Stockholm Centre for Eating Disorders at the Karolinska Institute designed a new treatment unit, Eira, especially designed for SEED patients. A team at the Karolinksa Institute recently described their ongoing study investigating whether an individualized case management program approach could improve SEED patients’ quality of life, help control their healthcare costs, reduce eating disorder symptoms, and improve access to and voluntary use of available health care.

Patients who are candidates for case management often are seriously ill and in distress because of physical and financial strain, social problems, combined with anxiety, depression and compulsive behaviors. Ironically, some SEED patients appear to be well and thus are ambivalent about treatment. For some clinicians, a patient who has “tried everything” without a positive result may appear “unmotivated” and subsequently dismissed from treatment.

Case management systems

In the past, case management approaches have been aimed at adult patients with severe mental disabilities such as schizophrenia, severe addictive disorders, and psychoses. The case management method offers individualized care, which may last a few months to several years, and there is no time limit for the intervention.

The Eira unit accepts patients who have had an ED for at least 10 years and who have failed at least three treatment programs. All patients undergo a semi-structured diagnostic interview, a qualitative interview, and then complete several self-report questionnaires. Data from medical records are also collected. The program is designed so that the diagnostic interview and self-report assessments are done at follow-ups after 1, 2, and 3 years in the program.

The program can manage up to 30 patients simultaneously. The main activity involves clinical contact with a clinical case manager through supportive conversations. The case manager also has a role in treatment, for example, by providing social training, ways to control symptoms, and family support. According to the authors, the individual patient’s needs and references drive the frequency, setting, and form of the meetings. With the patient’s consent, relatives are invited to participate in the intervention, and special lectures for family members (without the patient) are offered twice a year. According to the authors, clinical outcome and cost-effectiveness will be carefully analyzed at the end of the current study.

The authors also note that the program offers an alternative to more traditional treatment, which is aimed at reducing the patient’s symptoms; instead, the case management approach prioritizes function and quality of life. It will be of great interest to see the final outcomes of this study.