Variations in Admission Practices for Adolescents with Anorexia Nervosa: A North American Sample

Schwartz, Beth I.; Mansbach, Jonathan M.; Marion, Jenna G.; Katzman, Debra K.; Forman, Sara F.

doi:10.1016/j.jadohealth.2008.04.010

Cited by 67 publications

(53 citation statements)

References 34 publications

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“…Outro aspecto a ser considerado é a experiência adquirida pelos profissionais dos serviços para o manejo dos casos mais graves, o que também contribuiu para diminuição da hospitalização integral em primeira instância [17][18][19] . As indicações para hospitalização, desde o início do funcionamento do serviço até os dias atuais, seguem critérios clínicos claramente estabelecidos, por exemplo: peso corporal abaixo de 75% do esperado, bradicardia, hipotensão, distúrbios hidroeletrolíticos graves, comprometimento orgânico, falta de suporte ambiental e/ou risco de suicídio 2,20 .…”

Section: Discussionunclassified

Hospitalização integral para tratamento dos transtornos alimentares: a experiência de um serviço especializado

Palma

Santos

Ribeiro

2013

J. bras. psiquiatr.

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RESUMOObjetivo: Descrever as características da hospitalização integral para o tratamento de transtornos alimentares em um serviço especializado de Ribeirão Preto, SP. Métodos: Foram revisados todos os prontuários dos pacientes em seguimento pelo serviço, de 1982 até 2011, especialmente aqueles que tiveram indicação de internação integral. Foram coletados dados sociodemográficos e referentes ao diagnóstico. Resultados: No período referido, 186 pacientes receberam atendimento pelo serviço e, desses, 44,6% (n = 83) foram internados para tratamento. Ao longo do tempo, houve redução na relação atendimento/internação, passando de 77,7% para 36,2% dos casos. A média de internações foi de 1,9 ± 3,9 vezes, e 73,5% (n = 61) dos pacientes foram hospitalizados apenas uma vez. A duração média da internação, independentemente do número de hospitalizações, foi de 70,6 ± 115,9 dias (variação de 3 a 804 dias). A predominância foi do sexo feminino, raça branca, solteira, sem filhos e com idade média de 23,3 ± 10,8 anos. O diagnóstico predominante foi de anorexia nervosa (85,5%), sobretudo em seu tipo restritivo (54,2%). As indicações mais frequentes para internação foram para realização de terapia nutricional (50,9%), seguida da investigação do quadro clínico (30,1%) e por causa de depressão e/ou ideação suicida (10,9%). Conclusão: A hospitalização integral é uma modalidade terapêutica necessária para o tratamento desses quadros, e sua frequência foi considerada significativa, porém diminuiu ao longo do tempo. Esse resultado pode ser explicado pela tendência de desospitalização a partir da reforma psiquiátrica, do diagnóstico e tratamento mais precoces e da experiência adquirida pelos profissionais do serviço ao longo dos anos. ABSTRACTObjective: To describe the characteristics of inpatient treatment for eating disorders in a specialized service in Ribeirao Preto, SP. Methods: We reviewed all the medical records of patients followed up for the service between 1982 and 2011, particularly those who received inpatient treatment. Sociodemographic data and related to diagnosis were collected. Results: In the said period, 186 patients were treated by the service and 44.6% (n = 83)

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Section: Discussionunclassified

Hospitalização integral para tratamento dos transtornos alimentares: a experiência de um serviço especializado

Palma

Santos

Ribeiro

2013

J. bras. psiquiatr.

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“…It is not consistent whether anorexia nervosa patients are treated with an adjunctive refeeding method (liquid nutrition via an NG tube and TPN) or how these treatments are conducted among hospitals or physicians, according to previous studies [6,13]. In our database, 80 cases were treated with TPN and 45 cases were treated with NG tube nutrition.…”

Section: Bmi Body Mass Indexmentioning

confidence: 93%

“…Some guidelines recommend that anorexia nervosa patients with less than 75 % of the average BMI (=16.5) should be admitted; however, these guidelines are not based on strict evidence [6]. We examined the effect of BMI upon admission on in-hospital mortality of anorexia nervosa, using a national inpatient database.…”

Section: Introductionmentioning

confidence: 99%

Body mass index and in-hospital mortality in anorexia nervosa: data from the Japanese Diagnosis Procedure Combination Database

et al. 2013

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One of the main purposes of admission for anorexia nervosa is to manage acute medical conditions related to this condition. Factors associated with in-hospital mortality in anorexia nervosa remain unclear. This study describes the clinical features of anorexia nervosa patients requiring hospitalization in Japan. We analyzed the association between in-hospital mortality and body mass index upon admission using a currently available, nationwide hospital-based database. We identified 669 eligible patients with anorexia nervosa (BMI ≤ 16.5) from 229 hospitals between July and December, 2010. More than 90 % of the patients were female and 100 patients were admitted involuntarily. The average body mass index was 13.1, and the in-hospital mortality rate was 0.7 %. Five patients who died had a BMI under 11, indicating that patients with an extremely low BMI may be likely to die, despite admission.

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“…In the current literature, criteria for hospitalization for adolescent patients with an ED are clear but are applied differently in various clinics in different countries depending on the health care systems 4 . Yet, no standard protocols are present for the initial stages of refeeding or the length of recovery and different models for hospitalization programs have been described.…”

mentioning

confidence: 99%

“…Yet, no standard protocols are present for the initial stages of refeeding or the length of recovery and different models for hospitalization programs have been described. Although all programs provide stabilization of acute and severe medical complications, duration of inpatient management and approach to refeeding may change according to the center the patient receives treatment 4 . While some centers offer specialized inpatient care on wards specifically designated for EDs only, others like ours offer treatment on general pediatric wards designated for the adolescent age group but not specific for ED, where the ward staff have no psychiatric training.…”

mentioning

confidence: 99%

Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do?

Akgül¹,

Kızılkan²,

Örs³

et al. 2016

Turk J Pediatr

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There are a range of different services for treating adolescent eating disorders (ED) but there is no clinical consensus and a paucity of research indicating which type of treatment setting is the best. Although it would be ideal to have a specialized ward for these patients what happens when this is not possible? The aim of this study was to evaluate patients with ED hospitalized on a general pediatric ward. A retrospective chart review for 37 patients hospitalized for an ED and followed by a team consisting of an adolescent medicine specialist, a child and adolescent psychiatrist and a dietician on a pediatric ward were re-evaluated. Twenty-four (64.9%) patients were diagnosed with anorexia nervosa (AN) restricting type, 8 (21.6%) with anorexia nervosa binging purging type, 3 (8.1%) with bulimia nervosa (BN) and 2 (5.4%) with eating disorder otherwise not specified. The mean age at admission was 14.79 ± 1.75 years and 7 (20%) were males. A majority were hospitalized due to medical instability. Mean period of time from admittance to medical stabilization was 6.04 ± 4.79 days. The mean period of admittance was 26.4 ± 11.9 days for AN and 23.7 ± 15.03 days for BN patients. The mean calorie intake of the AN group was 607 ± 333 kcal and 2,358 ± 605 kcal at hospitalization and discharge, respectively. Hypophosphatemia occurred in 2 patients during refeeding. Mean total weight gained during the whole hospitalization period was 3,950 ± 3,524grs. This study shows that although not ideal, EDs can successfully be followed on general pediatric wards and could have implications at centers with no specialized wards.

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Variations in Admission Practices for Adolescents with Anorexia Nervosa: A North American Sample

Cited by 67 publications

References 34 publications

Hospitalização integral para tratamento dos transtornos alimentares: a experiência de um serviço especializado

Hospitalização integral para tratamento dos transtornos alimentares: a experiência de um serviço especializado

Body mass index and in-hospital mortality in anorexia nervosa: data from the Japanese Diagnosis Procedure Combination Database

Type of setting for the inpatient adolescent with an eating disorder: Are specialized inpatient clinics a must or will the pediatric ward do?

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