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MARSIPAN: management of really sick patients with anorexia nervosa

  • Paul Robinson and William Rhys Jones
Summary

Anorexia 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 settings

DECLARATION OF INTEREST

None.

Copyright
Corresponding author
Correspondence Dr Paul Robinson, Eating Disorders Service, Barnet, Enfield and Haringey Mental Health Trust, St Ann's Hospital, St Ann's Road, London N15 3TH, UK. Email: p.robinson@ucl.ac.uk
References
Hide All
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Arcelus, J, Mitchell, AJ, Wales, J, et al. (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Archives of General Psychiatry, 68: 724–31.
Birmingham, CL, Treasure, J (2010) Medical Management of Eating Disorders. Cambridge University Press.
British Medical Association (2016) Mental capacity tool kit. BMA (https://www.bma.org.uk/advice/employment/ethics/mental-capacity/mental-capacity-toolkit). Accessed 18 November 2017.
Campbell, K, Peebles, R (2014) Eating disorders in children and adolescents: state of the art review. Pediatrics, 134: 582–92.
Curtice, M, James, L (2016) Faith, ethics and Section 63 of the Mental Health Act 1983. BJPsych Bulletin, 40: 7781.
Deasy, C, Bray, JE, Smith, K, et al. (2011) Out-of-hospital cardiac arrests in young adults in Melbourne, Australia – adding coronial data to a cardiac arrest registry. Resuscitation, 82: 1302–6.
Department for Constitutional Affairs (2007) Mental Capacity Act 2005: Code of Practice. TSO (The Stationery Office.
Department of Health (2015) Mental Health Act 1983: Code of Practice. Department of Health.
Dold, M, Aigner, M, Klabunde, M, et al. (2015) Second-generation antipsychotic drugs in anorexia nervosa: a meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 84: 110–6.
Emborg, C (1999) Mortality and causes of death in eating disorders in Denmark 1970–1993: a case register study. International Journal of Eating Disorders, 25: 243–51.
Gaudiani, JL, Mehler, PS (2016) Rare medical manifestations of severe restricting and purging: “Zebras,” missed diagnoses, and best practices. International Journal of Eating Disorders, 49: 331–44.
Hanachi, M, Melchior, JC, Crenn, P (2013) Hypertransaminasemia in severely malnourished adult anorexia nervosa patients: risk factors and evolution under enteral nutrition. Clinical Nutrition, 32: 391–5.
Harjutsalo, V, Forsblom, C, Groop, PH (2011) Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ, 343: d5364.
Hirose, K, Hirose, M, Tanaka, K, et al. (2014) Perioperative management of severe anorexia nervosa. British Journal of Anaesthesia, 112: 246–54.
Hoek, HW (2006) Incidence, prevalence and mortality of anorexia nervosa and other eating disorders. Current Opinion in Psychiatry, 19: 389–94.
Jensen, VS, Mejlhede, A (2000) Anorexia nervosa: treatment with olanzapine. British Journal of Psychiatry, 177: 87.
Mayo Clinic (2015) Hypoglycemia: causes. Mayoclinic.org (http://www.mayoclinic.org/diseases-conditions/hypoglycemia/basics/causes/con-20021103). Accessed 18 November 2017.
Mehler, PS, Crews, C, Weiner, K (2004) Bulimia: medical complications. Journal of Women's Health, 13: 668–75.
Mehler, PS, Brown, C (2015) Anorexia nervosa - medical complications. Journal of Eating Disorders, 3: 11.
Mental Health Act Commission (2004) Guidance on the Treatment of Anorexia Nervosa under the Mental Health Act 1983. MHAC (available at http://www.seedeatingdisorders.org.uk/pdfs/user/F3774357-49CE-5BCB-F9BB-22ECC4C430E5.pdf).
Mont, L, Castro, J, Herreros, B, et al. (2003) Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. Journal of the American Academy of Child and Adolescent Psychiatry, 42: 808–13.
National Collaborating Centre for Mental Health (2017) Eating disorders: recognition and treatment (https://www.nice.org.uk/guidance/ng69). Accessed 8/12/17.
National Institute for Health and Care Excellence (2006) Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (CG32). NICE.
Nielsen, S, Moller-Madsen, S, Isager, T, et al. (1998) Standardized mortality in eating disorders – a quantitative summary of previously published and new evidence. Journal of Psychosomatic Research, 44: 413–34.
O'Connor, G, Nicholls, D (2013) Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review. Nutrition in Clinical Practice, 28: 358–64.
Prospective Studies Collaboration (2009) Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet, 373: 1083–96.
Ringbaek, T, Seersholm, N, Viskum, K (2005) Standardised mortality rates in females and males with COPD and asthma. European Respiratory Journal, 25: 891–5.
Robinson, PH (2006) Community Treatment of Eating Disorders. John Wiley & Sons.
Robinson, PH (2012) Avoiding deaths in hospital from anorexia nervosa: the MARSIPAN project. Psychiatrist, 36: 109–13.
Robinson, PH, Nicholls, D (2015) Critical Care for Anorexia Nervosa: The MARSIPAN Guidelines in Practice. Springer.
Royal College of Psychiatrists, Royal College Physicians, Royal College of Pathologists (2014) MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa (2nd edn) (College Report CR189). Royal College of Psychiatrists.
Sachs, K, Andersen, D, Sommer, J, et al. (2015) Avoiding medical complications during the refeeding of patients with anorexia nervosa. Eating Disorders, 23: 411–21
Sachs, KV, Harnke, B, Mehler, PS, et al. (2016) Cardiovascular complications of anorexia nervosa: a systematic review. International Journal of Eating Disorders, 49: 238–48.
Steinhausen, HC (2002) The outcome of anorexia nervosa in the 20th century. American Journal of Psychiatry, 159: 1284–93.
Suokas, JT, Suvisaari, JM, Gissler, M, et al. (2013) Mortality in eating disorders: a follow-up study of adult eating disorder patients treated in tertiary care, 1995–2010. Psychiatry Research, 210: 1101–6.
Tan, JO, Stewart, A, Fitzpatrick, R, et al. (2010) Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. International Journal of Law and Psychiatry, 33: 1319.
Tan, J, Richards, L (2015) Legal and ethical issues in the treatment of really sick patients with Anorexia Nervosa. In Critical Care for Anorexia Nervosa (eds Robinson, P, Nicholls, D). Springer.
Thiels, C (2008) Forced treatment of patients with anorexia. Current Opinion in Psychiatry, 21: 495–8.
Thiels, C, Curtice, MJR (2009) Forced treatment of anorexic patients: part 2. Current Opinion in Psychiatry, 22: 497500.
Westmoreland, P, Krantz, MJ, Mehler, PS (2016) Medical complications of anorexia nervosa and bulimia. American Journal of Medicine, 129: 30–7.
Zhao, X (2017) Gelatinous transformation. PathologyOutlines.com website (http://www.pathologyoutlines.com/topic/bonemarrowseroustransformation.html). Accessed 18 November 2017.
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MARSIPAN: management of really sick patients with anorexia nervosa

  • Paul Robinson and William Rhys Jones
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