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January 2011



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Article Date: 14 Oct 2010 – 4:00 PDT

New guidelines published by the Royal College of Psychiatrists (RCPsych) and the Royal College of Physicians (RCP) hope to reduce the number of avoidable deaths of patients with severe anorexia nervosa on general medical units.

The guidelines are aimed at all medical, nursing and dietetic staff working in hospitals to which a patient with severe anorexia nervosa could be admitted. They provide advice on the physical assessment of patients, required members of the in-patient medical team, the use of mental health legislation, and advice for commissioners on required services for this group of very ill patients.

The guidelines have been produced by the MARSIPAN working group, which stands for the MAnagement of Really SIck Patients with Anorexia Nervosa. The group was established in 2008 because of serious concerns over the number of deaths of young people with severe anorexia on general medical wards. Some died from medical complications such as pneumonia. Others died from, re-feeding syndrome (RFS) when food intake is increased too rapidly after weeks of starvation, or from “underfeeding syndrome” when nutrition intake is increased too slowly.

Most people with severe anorexia nervosa should be treated on specialist eating disorder units (SEDU). However, they may be admitted to a medical ward if a SEDU bed is not available, or if they need treatments that are not available on a psychiatric ward such as intravenous infusions or artificial ventilation. Anorexia nervosa has one of the highest mortalities of any psychiatric condition, and some deaths are inevitable. But patients admitted to medical wards are often at high risk and may not be seen by staff with specialist knowledge.

The guidelines make 9 key recommendations including:

– Physical risk assessment in these patients should include body mass index (BMI), physical examination, including muscle power, blood tests and electrocardiography (ECG).  

Read in Full:  http://www.medicalnewstoday.com/articles/204570.php

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