MARSIPAN: management of really sick patients with anorexia nervosa

Abstract

SUMMARYAnorexia nervosa is a potentially fatal illness that affects women and a smaller proportion of men. When a patient becomes so severely ill that admission to a medical unit is required, the risk of a poor outcome is high. Most medical services do not have sufficient expertise, without psychiatric help, to manage the nutritional, medical, behavioural and family problems that often appear. These problems interact and this can adversely affect outcome. This article discusses, with reference to the MARSIPAN report, the procedure that should be followed when such a patient presents to an acute medical service. It considers diagnosis, risk assessment, consent, re-feeding syndrome, underfeeding syndrome and treatment-sabotaging behaviours. It stresses the importance of collaboration between expert medical and psychiatric staff, and involvement of the family. When these issues are adequately addressed, the outcome for the patient is more likely to be positive.LEARNING OBJECTIVES•Be confident in diagnosing individuals with anorexia nervosa and identify when urgent in-patient medical treatment is required•Be confident in assessing and managing physical risk in individuals with anorexia nervosa•Be aware of the Royal College of Psychiatrists’ MARSIPAN report and its implications for the management of individuals with eating disorders in medical settingsDECLARATION OF INTERESTNone.

Refeeding syndrome : physiological background and practical management

“…Deposition of fatty acids and triglycerides in the liver can lead to an acute fatty liver often being detected through raised liver transaminases. Moderate abnormalities of liver function (eg, alanine transaminase up to 10 times the upper limit of the normal range) should not delay feeding 16…”

Experience of management of anorexia nervosa patients with extremely severe malnutrition in a transdisciplinary eating disorders inpatient unit

“…The question of where to hospitalize extremely malnourished patients with AN is a real concern raised in the literature by psychiatric teams specialized in the management of AN (27) (28). It may seem like a dilemma.…”

“…On the other hand, medical doctors have to face the resistance to treatment inherent to patients with AN (denial, treatment refusal, ambivalence about treatment) » and psychic decompensations that would justify admission to a psychiatric ward (27). This problem is mentioned in the MARSIPAN report which speci es that specialist-ED-units are not suitable for treating severe medical complications (28). Thus, a survey in specialist-ED-units published by the MARSIPAN working group showed that services could not offer intravenous infusion, parenteral nutrition and treatment of serious medical complications in these units.…”

Experience of Management of Anorexia Nervosa Patients With Extremely Severe Malnutrition In A Transdisciplinary Eating Disorders Inpatient Unit

“…Distribution of facilities receiving patients after discharge from the unit (N=386).The question of where to hospitalize extremely malnourished AN patients is a real concern raised in the literature by psychiatric teams specialized in the management of AN(24) (25). It may seem like a dilemma.…”

“…On the other hand, medical doctors have to face the resistance to treatment inherent to AN patients (denial, treatment refusal, ambivalence about treatment) » and psychic decompensations that would justify admission to a psychiatric ward(24). This problem is mentioned in the MARSIPAN report which specifies that specialist ED units (SEDUs) are not suitable for treating severe medical complications(25). Thus, a survey in SEDUs published by the MARSIPAN working group showed that services SEDU could not offer intravenous infusion, parenteral nutrition and treatment of serious medical complications.…”