Clinical Trajectories Associated with Pharmacological Treatment Patterns in Female Adolescents with Anorexia Nervosa: A 12-Month Retrospective Study in Italian Real-World Clinical Practice.

Background

Pharmacological treatments are frequently prescribed for adolescents with anorexia nervosa (AN), mainly to address psychiatry comorbidities and associated clinical features, although evidence supporting medication-specific effects remains limited. This retrospective study examined 12-month clinical trajectories associated with different pharmacological treatment patterns in a cohort of female adolescents with AN admitted to a tertiary university hospital.

Methods

Clinical records of 102 female patients aged 12-18 years with AN were retrospectively reviewed. Participants were first classified according to whether they received any pharmacological treatment and were subsequently divided into six groups: no medication, antidepressants, antipsychotics, mood stabilizers, combination therapy, and medication switching. Body mass index (BMI), Clinical Global Impression-Severity (CGI-S), Children's Global Assessment Scale (C-GAS), and item 40 of the Structured Interview for Anorexic and Bulimic Syndromes-Expert Form (SIAB-EX) were evaluated at admission (T0, before treatment initiation), at 6-month follow-up (T1), and at 12-month follow-up (T2).

Results

BMI improved significantly over time across all treatment groups. Compared with participants who received any form of pharmacological treatment, the non-medicated group exhibited a significantly greater increase in mean CGI-S scores and significantly greater reductions in mean C-GAS and SIAB-EX scores. Baseline comparison among the six treatment groups showed significant differences in CGI-S, C-GAS, and SIAB-EX item 40 scores, indicating that the groups were not fully comparable in terms of initial clinical severity, global functioning, and physical hyperactivity. Patients in the medication-switching group generally showed smaller improvements, whereas findings in the mood-stabilizer group should be interpreted cautiously because of the very small sample size.

Conclusions

In this real inpatients cohort, adolescents with AN showed clinical improvement over 12 months across different pharmacological treatment patterns. However, baseline differences between groups and the non-randomized retrospective design preclude causal conclusions regarding medication-specific effectiveness. These findings should be interpreted as descriptive clinical trajectories associated with treatment patterns selected in routine care. Further prospective studies with standardized treatment data and adequately powered subgroups are needed.