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Background Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). Methods The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Etienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. Results Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. Conclusion There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Resume L’hospitalisation des adolescentes anorexiques est frequemment longue et vient elle-meme s’articuler a une prise en charge qui a pu mobiliser plusieurs modalites de soins en amont. L’accompagnement de la famille dans le traitement de l’anorexie mentale a l’adolescence est un axe de travail fondamental dans le contexte de l’hospitalisation. Comme transition en fin de cette hospitalisation, la mise en place d’un repas familial therapeutique associant familles et soignants vient s’inscrire dans un rite de passage que l’hospitalisation va incarner pour l’adolescente malade et sa famille. Cet abord rituel, une reflexion socio-anthropologique, la question du statut de l’adolescent malade, en hospitalisation et dans sa famille, la transition entre l’hopital et la maison, la nature de la relation soignants–soignes, sont autant de themes permettant de comprendre l’interet singulier du repas familial therapeutique.

Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up).The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed.Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/mThere is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Resume Les troubles de conversion ont une prevalence notable en population neuropediatrique. Ils mobilisent de multiples professionnels de sante dans la prise en charge. Les donnees actuelles de la litterature sur le devenir des troubles de conversion sont limitees et la place des comorbidites ainsi que leur evolution ont rarement ete evaluees chez les jeunes. Cette revue de la litterature etudie l’evolution des troubles de conversion en terme de guerison et les comorbidites psychiatriques associees chez les enfants et adolescents. La revue s’est faite a partir d’une recherche sur Pubmed et PsychInfo, ou 11 etudes ont repondu aux criteres d’inclusion : (i) trouble de conversion repondant aux criteres du DSM, (ii) population pediatrique, (iii) etudes longitudinales evaluant le devenir du trouble de conversion et/ou les comorbidites psychiatriques. La plupart des troubles de conversion chez les enfants et adolescents a evolue favorablement, avec disparition de la symptomatologie conversive, dans 70 a 92 % des cas, pour une duree de suivi variant de 1 a 6 ans. Les comorbidites psychiatriques associees au trouble concernaient entre 13 et 84 % des enfants et adolescents selon les etudes. Vingt-huit a 41 % de cette population pediatrique a presente un trouble psychiatrique a distance de la symptomatologie conversive. Les principales comorbidites retrouvees etaient des troubles anxieux et des troubles de l’humeur. Bien que les troubles de conversion evoluent majoritairement vers une guerison chez les enfants et adolescents, le pronostic de cette pathologie est plus sombre devant la persistance ou la survenue a distance de comorbidites psychiatriques.

After publication of our article [1] the authors have notified us of missing to include one name to the authorship list.