Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group

Gaudiani, Jennifer L.; Brinton, John T.; Sabel, Allison L.; Rylander, Melanie; Catanach, Brittany; Mehler, Philip S.

doi:10.1002/eat.22437

Cited by 27 publications

(25 citation statements)

References 25 publications

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“…Despite the few comparators, we found that key demographics of our population were largely concordant with other centres. [13][14][15][16][17] In addition, the high frequency of comorbid psychiatric illness in our cohort was consistent with data from Buhren et al, 18 who described comorbid illness in 47.3% of patients with first presentation AN, and Fichter et al, 19 who reported comorbid Axis I disease in 76.6% of 103 prospectively recruited AN inpatients.…”

Section: Discussionsupporting

confidence: 91%

“…[13][14][15][16][17] In addition, the high frequency of comorbid psychiatric illness in our cohort was consistent with data from Buhren et al, 18 who described comorbid illness in 47.3% of patients with first presentation AN, and Fichter et al, 19 who reported comorbid Axis I disease in 76.6% of 103 prospectively recruited AN inpatients. [13][14][15][16][17] In addition, the high frequency of comorbid psychiatric illness in our cohort was consistent with data from Buhren et al, 18 who described comorbid illness in 47.3% of patients with first presentation AN, and Fichter et al, 19 who reported comorbid Axis I disease in 76.6% of 103 prospectively recruited AN inpatients.…”

Section: Inpatient Management Of Anorexia Nervosasupporting

confidence: 91%

“…Literature examining acute medical outcomes in adults with moderate-to-severe AN is relatively sparse, and a preponderance of published data draws from a single centre in the United States. [13][14][15][16][17] There are no Australian data that specifically address acute inpatient medical stabilisation of AN in adults. Furthermore, crosssectional evaluation of haemodynamics during medical stabilisation has only been reported in a single cohort of adult patients.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] There are no Australian data that specifically address acute inpatient medical stabilisation of AN in adults. [13][14][15][16][17] There are no Australian data that specifically address acute inpatient medical stabilisation of AN in adults.…”

Section: Inpatient Management Of Anorexia Nervosamentioning

confidence: 99%

See 3 more Smart Citations

Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care

Braude

Con

Clayton‐Chubb

et al. 2020

Internal Medicine Journal

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Background Patients with anorexia nervosa (AN) are vulnerable to physiological decompensation and often require inpatient management by an eating disorders unit. Aims Patients admitted to an Australian tertiary medical centre for medical stabilisation of AN were assessed as part of quality assurance. Analysis included: (i) medical complications during acute inpatient stabilisation; (ii) predictors of refeeding syndrome; (iii) predictors governing length of stay (LOS); and (iv) outcomes pre‐ and post‐implementation of multidisciplinary treatment guidelines. Methods A retrosepctive analysis of 95 consecutive admissions (60 individual patients) between November 2011 and August 2017 was performed. Results Patients had a median LOS of 9.6 days (interquartile range 5.8–19.7) and a mean weight gain of 1.4 kg (standard deviation 2.9). Medical complications included the following: hypoglycaemia (11.6%) and refeeding electrolyte derangement (26.3%). Advancing age (odds ratio (OR) 1.06 per year, P = 0.019), nasogastric tube requirement (OR 3.4, P = 0.014) and Code Grey(s) (security calls) (OR 7.1, P = 0.010) were associated with refeeding electrolyte derangement. Parameters associated with increased LOS included the following: lower body mass index (P = 0.029), Code Grey(s) (P = 0.029) and tachycardia (P = 0.013). Following multivariate analysis, the post‐guidelines implementation group required less intravenous fluid and electrolyte replacement, though had lower rates of refeeding electrolyte derangement (OR 0.33 (0.11–0.99)). Conclusion Patients with moderate to severe AN are at risk of dangerous medical complications, and older patients may have heightened predisposition to refeeding electrolyte derangement. Early identification of medically high‐risk patients is imperative to implement timely, life‐saving interventions.

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Section: Discussionsupporting

confidence: 91%

Section: Inpatient Management Of Anorexia Nervosasupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Inpatient Management Of Anorexia Nervosamentioning

confidence: 99%

See 2 more Smart Citations

Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care

Braude

Con

Clayton‐Chubb

et al. 2020

Internal Medicine Journal

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“…One should keep in mind though, while interpreting the results of our study, that a diagnosis of AN did neither require that AN was the leading current diagnosis nor that it was the first episode of AN. Second, current research has highlighted the occurrence of AN in mid-life and older adults [32,33,49]. Third, studies in AN have used different upper age limits, for example, 40 years of age [20,31], even though other studies have shown that in a relevant proportion of people with AN is first diagnosed or first treated after the age of 40 [32,33].…”

Section: Comparison To Previous Researchmentioning

confidence: 99%

Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa

Himmerich

Hotopf

Shetty

et al. 2018

Eur Arch Psychiatry Clin Neurosci

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Anorexia nervosa (AN) is found associated with increased mortality. Frequent comorbidities of AN include substance use disorders (SUD), affective disorders (AD) and personality disorders (PD). We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders in the observation window between January 2007 and March 2016 for 1970 people with AN, using data from the case register of the South London and Maudsley (SLaM) NHS Foundation Trust, an almost monopoly-secondary mental healthcare service provider in southeast London. We retrieved data from its Clinical Records Interactive Search (CRIS) system as data source. Mortality was ascertained through nationwide tracing by the UK Office for National Statistics (ONS) linked to CRIS database on a monthly basis. A total of 43 people with AN died during the observation period. Standardized Mortality Ratio (SMR) with England and Wales population in 2012 as standard population for our study cohort was 5.21 (95% CI 3.77, 7.02). In univariate analyses, the comorbidity of SUD or PD was found to significantly increase the relative risks of mortality (HRs = 3.10, 95% CI 1.21, 7.92; and 2.58, 95% CI 1.23, 5.40, respectively). After adjustment for demographic and socioeconomic covariates as confounders, moderately but not significantly elevated risks were identified for SUD (adjusted HR = 1.39, 95% CI 0.53, 3.65) and PD (adjusted HR = 1.58, 95% CI 0.70, 3.56). These results suggest an elevated mortality in people with AN, which might be, at least partially, explained by the existence of the comorbidities SUD or PD.

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Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis

Broomfield

Stedal

Touyz

et al. 2017

Intl J Eating Disorders

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Medical outcomes for adults hospitalized with severe anorexia nervosa: An analysis by age group

Abstract: Results demonstrate medical abnormalities and response to medical stabilization in severely ill AN patients during hospitalization were mostly similar across the age span. This information should allay fears that the effect of age will make medical stabilization more difficult.

Cited by 27 publications

References 25 publications

Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care

Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care

Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa

Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis

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