Abstract
Inpatient treatment for Anorexia Nervosa (AN) is the most intensive level of care, often aimed at emergency renutrition. As per international guidelines, vital signs alterations, psychiatric symptoms, Body Mass Index (BMI) thresholds (extreme when <15 kg/m2), and severe rate of weight loss (>1 kg/week) should all be used as indicators of severity when considering hospitalization. Hospital care must be multidisciplinary and integrated, and caregivers should be involved in the treatment decision whenever possible. Weight gain (0.5–1.4 kg/week) aiming at weight restoration is the main goal of nutritional rehabilitation and is achieved mainly through oral diet, nutritional supplements, and tube feeding, alone or combined. Caloric prescriptions (starting from 5–20 kcal/kg and increasing every 2–4 days) must be balanced to avoid both refeeding and underfeeding syndromes. Psychological treatments during hospitalization are useful in sustaining weight recovery, and clinicians should value therapeutic alliance and interventions fostering patient motivation. The use of psychoactive drugs can be useful in treating psychiatric comorbidities, however not in pursuing weight gain. Clinicians should be aware that rehospitalization is common, mostly due to symptoms’ persistence after discharge. On this line, inpatient and outpatient services should collaborate to promote continuity of care.
References
Abbate-Daga G, Facchini F, Marzola E et al (2014) Health-related quality of life in adult inpatients affected by anorexia nervosa. Eur Eat Disord Rev 22:285–291. https://doi.org/10.1002/erv.2302
American Psychiatric Association (2013) DSM-5
Atti AR, Mastellari T, Valente S et al (2021) Compulsory treatments in eating disorders: a systematic review and meta-analysis. Eat Weight Disord 26:1037–1048. https://doi.org/10.1007/S40519-020-01031-1
Baiano M, Salvo P, Righetti P et al (2014) Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry 14:165. https://doi.org/10.1186/1471-244X-14-165
Baran SA, Weltzin TE, Kaye WH (1995) Low discharge weight and outcome in anorexia nervosa. Am J Psychiatry 152:1070–1072. https://doi.org/10.1176/AJP.152.7.1070
Bargiacchi A, Clarke J, Paulsen A, Leger J (2019) Refeeding in anorexia nervosa. Eur J Pediatr 178:413–422. https://doi.org/10.1007/S00431-018-3295-7
Born C, de la Fontaine L, Winter B et al (2015) First results of a refeeding program in a psychiatric intensive care unit for patients with extreme anorexia nervosa. BMC Psychiatry 15:57. https://doi.org/10.1186/S12888-015-0436-7
Braude MR, Con D, Clayton-Chubb D et al (2020) Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care. Intern Med J 50:77–85. https://doi.org/10.1111/IMJ.14329
Brigham KS, Manzo LD, Eddy KT, Thomas JJ (2018) Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents. Curr Pediatr Rep 6:107. https://doi.org/10.1007/S40124-018-0162-Y
Bryan DC, Cardi V, Willmott D et al (2021) A systematic review of interventions to support transitions from intensive treatment for adults with anorexia nervosa and/or their carers. Eur Eat Disord Rev 29:355–370. https://doi.org/10.1002/ERV.2824
Calugi S, el Ghoch M, Conti M, Dalle Grave R (2018) Preoccupation with shape or weight, fear of weight gain, feeling fat and treatment outcomes in patients with anorexia nervosa: a longitudinal study. Behav Res Ther 105:63–68. https://doi.org/10.1016/J.BRAT.2018.04.001
Cass K, Mcguire C, Bjork I et al (2020) Medical complications of anorexia nervosa. Psychosomatics 61:625–631
Cassioli E, Sensi C, Mannucci E et al (2020) Pharmacological treatment of acute-phase anorexia nervosa: evidence from randomized controlled trials. J Psychopharmacol (Oxford, England) 34:864–873. https://doi.org/10.1177/0269881120920453
Chatelet S, Wang J, Gjoertz M et al (2020) Factors associated with weight gain in anorexia nervosa inpatients. Eat Weight Disord 25:939–950. https://doi.org/10.1007/S40519-019-00709-5
Cliffe C, Shetty H, Himmerich H et al (2020) Suicide attempts requiring hospitalization in patients with eating disorders: a retrospective cohort study. Int J Eat Disord 53:728–735. https://doi.org/10.1002/EAT.23240
Cuerda C, Vasiloglou MF, Arhip L (2019) Nutritional management and outcomes in malnourished medical inpatients: anorexia nervosa. J Clin Med 8:1042. https://doi.org/10.3390/JCM8071042
Cuntz U, Körner T, Voderholzer U (2021) Rapid renutrition improves health status in severely malnourished inpatients with AN - score-based evaluation of a high caloric refeeding protocol in severely malnourished inpatients with anorexia nervosa in an intermediate care unit. Eur Eat Disord Rev. https://doi.org/10.1002/ERV.2877
da Silva JSV, Seres DS, Sabino K et al (2020) ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract 35:178–195. https://doi.org/10.1002/NCP.10474
Dalle Grave R, el Ghoch M, Sartirana M, Calugi S (2016) Cognitive behavioral therapy for anorexia nervosa: an update. Curr Psychiatry Rep 18:1–8. https://doi.org/10.1007/S11920-015-0643-4
Dittmer N, Voderholzer U, Mönch C et al (2020) Efficacy of a specialized group intervention for compulsive exercise in inpatients with anorexia nervosa: a randomized controlled trial. Psychother Psychosom 89:161–173. https://doi.org/10.1159/000504583
Dray J, Wade TD (2012) Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review. Clin Psychol Rev 32:558–565. https://doi.org/10.1016/J.CPR.2012.06.005
Edakubo S, Fushimi K (2020) Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis. BMC Psychiatry 20(1):19. https://doi.org/10.1186/s12888-020-2433-8
Eielsen HP, Vrabel KA, Hoffart A et al (2021) The 17-year outcome of 62 adult patients with longstanding eating disorders – a prospective study. Int J Eat Disord 54:841–850. https://doi.org/10.1002/eat.23495
el Ghoch M, Calugi S, Chignola E et al (2016) Body mass index, body fat and risk factor of relapse in anorexia nervosa. Eur J Clin Nutr 70:194–198. https://doi.org/10.1038/EJCN.2015.164
Elzakkers IFFM, Danner UN, Hoek HW et al (2014) Compulsory treatment in anorexia nervosa: a review. Int J Eat Disord 47:845–852. https://doi.org/10.1002/EAT.22330
Fassino S, Abbate-Daga G (2013) Resistance to treatment in eating disorders: a critical challenge. BMC Psychiatry 13:282
Garber AK, Sawyer SM, Golden NH et al (2016) A systematic review of approaches to refeeding in patients with anorexia nervosa. Int J Eat Disord 49:293–310
Gentile MG (2012) Enteral nutrition for feeding severely underfed patients with anorexia nervosa. Nutrients 4:1293–1303. https://doi.org/10.3390/NU4091293
Giel KE, Behrens SC, Schag K et al (2021) Efficacy of post-inpatient aftercare treatments for anorexia nervosa: a systematic review of randomized controlled trials. J Eat Disord 9:129. https://doi.org/10.1186/S40337-021-00487-5
Giombini L, Nesbitt S, Kusosa R, et al (2021) Neuropsychological and clinical findings of cognitive remediation therapy feasibility randomised controlled trial in young people with anorexia nervosa. Eur Eat Disord Rev. https://doi.org/10.1002/ERV.2874
Goddard E, Hibbs R, Raenker S et al (2013) A multi-centre cohort study of short term outcomes of hospital treatment for anorexia nervosa in the UK. BMC Psychiatry 13:287. https://doi.org/10.1186/1471-244X-13-287
Guinhut M, Melchior JC, Godart N, Hanachi M (2021) Extremely severe anorexia nervosa: hospital course of 354 adult patients in a clinical nutrition-eating disorders-unit. Clin Nutr 40:1954–1965. https://doi.org/10.1016/j.clnu.2020.09.011
Hale MD, Logomarsino JV (2019) The use of enteral nutrition in the treatment of eating disorders: a systematic review. Eat Weight Disord 24:179–198. https://doi.org/10.1007/S40519-018-0572-4
Halse C, Boughtwood D, Clarke S et al (2005) Illuminating multiple perspectives: meanings of nasogastric feeding in anorexia nervosa. Eur Eat Disord Rev 13:264–272. https://doi.org/10.1002/ERV.624
Halvorsen I, Rø Ø (2019) User satisfaction with family-based inpatient treatment for adolescent anorexia nervosa: retrospective views of patients and parents. J Eat Disord 7:1–12. https://doi.org/10.1186/S40337-019-0242-6
Harrison A, Stavri P, Ormond L et al (2018) Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: a treatment trial. Eur Eat Disord Rev 26:230–240. https://doi.org/10.1002/ERV.2584
Haruta I, Asakawa A, Inui A (2014) Olanzapine-induced hypoglycemia in anorexia nervosa. Endocrine 46:672–673. https://doi.org/10.1007/S12020-014-0235-9
Hay P (2020) Current approach to eating disorders: a clinical update. Intern Med J 50:24–29. https://doi.org/10.1111/imj.14691
Hay P, Chinn D, Forbes D et al (2014) Royal Australian and new Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 48:977–1008. https://doi.org/10.1177/0004867414555814
Haynos AF, Snipes C, Guarda A et al (2016) Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa. Int J Eat Disord 49:50–58. https://doi.org/10.1002/EAT.22469
Hebert PC, Weingarten MA (1991) The ethics of forced feeding in anorexia nervosa. CMAJ 144:141–144
Hessler JB, Diedrich A, Greetfeld M et al (2018) Weight suppression but not symptom improvement predicts weight gain during inpatient treatment for bulimia nervosa. Eur Eat Disord Rev 26:146–149. https://doi.org/10.1002/erv.2573
Kawai K, Yamashita S, Komaki G et al (2014) The outcome of treatment for anorexia nervosa inpatients who required urgent hospitalization. BioPsycho Soc Med 8:20. https://doi.org/10.1186/1751-0759-8-20
Kaye WH, Gwirtsman HE, Obarzanek E et al (1986) Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics. Am J Clin Nutr 44:435–443. https://doi.org/10.1093/AJCN/44.4.435
Kessler U, Rekkedal G, Rø Ø et al (2020) Association between gastrointestinal complaints and psychopathology in patients with anorexia nervosa. Int J Eat Disord 53:532–536. https://doi.org/10.1002/EAT.23243
Lock J, Litt I (2003) What predicts maintenance of weight for adolescents medically hospitalized for anorexia nervosa? Eat Disord 11:1–7. https://doi.org/10.1002/ERV.496
Lock J, Agras WS, le Grange D et al (2013) Do end of treatment assessments predict outcome at follow-up in eating disorders? Int J Eat Disord 46:771–778. https://doi.org/10.1002/EAT.22175
Long CG, Fitzgerald KA, Hollin CR (2012) Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting. Clin Psychol Psychother 19:1–13. https://doi.org/10.1002/cpp.738
Lund BC, Hernandez ER, Yates WR et al (2009) Rate of inpatient weight restoration predicts outcome in anorexia nervosa. Int J Eat Disord 42:301–305. https://doi.org/10.1002/EAT.20634
Madden S, Miskovic-Wheatley J, Wallis A et al (2015) A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychol Med 45:415–427. https://doi.org/10.1017/S0033291714001573
Mander J, Teufel M, Keifenheim K et al (2013) Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa. BMC Psychiatry 13:111. https://doi.org/10.1186/1471-244X-13-111
Martini M, Marzola E, Brustolin A, Abbate-Daga G (2021) Feeling imperfect and imperfectly feeling: a network analysis on perfectionism, interoceptive sensibility, and eating symptomatology in anorexia nervosa. Eur Eat Disord Rev. https://doi.org/10.1002/erv.2863
Marzola E, Nasser JA, Hashim SA et al (2013) Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment. BMC Psychiatry 13:290
Marzola E, Desedime N, Giovannone C et al (2015) Atypical antipsychotics as augmentation therapy in anorexia nervosa. PLoS One 10:e0125569. https://doi.org/10.1371/JOURNAL.PONE.0125569
Marzola E, Albini E, Delsedime N et al (2019) Therapeutic alliance in inpatients with severe anorexia nervosa. Eur Eat Disord Rev 27:671–681. https://doi.org/10.1002/erv.2687
Marzola E, Cavallo F, Pradella P, et al (2020a) A tasting experiment comparing food and nutritional supplement in anorexia nervosa. Appetite 155. https://doi.org/10.1016/J.APPET.2020.104789
Marzola E, Panero M, Cavallo F et al (2020b) Body shape in inpatients with severe anorexia nervosa. Eur Psychiatry 63:e2. https://doi.org/10.1192/J.EURPSY.2019.5
Marzola E, Longo P, Sardella F et al (2021a) Rehospitalization and “revolving door” in anorexia nervosa: are there any predictors of time to readmission? Front Psych 12:694223. https://doi.org/10.3389/FPSYT.2021.694223
Marzola E, Martini M, Brustolin A, Abbate-Daga G (2021b) Inpatients with severe-enduring anorexia nervosa: understanding the “enduringness” specifier. Eur Psychiatry 64:1–27. https://doi.org/10.1192/J.EURPSY.2021.2218
Mehler PS, Winkelman AB, Andersen DM, Gaudiani JL (2010) Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutrit Metab 2010:1–7. https://doi.org/10.1155/2010/625782
Money C, Genders R, Treasure J et al (2011) A brief emotion focused intervention for inpatients with anorexia nervosa: a qualitative study. J Health Psychol 16:947–958. https://doi.org/10.1177/1359105310396395
National Institute for Health and Care Excellence (NICE) (2017) Eating disorders: recognition and treatment NICE guideline. National Guideline Alliance (UK)
Olatunji BO, Levinson C, Calebs B (2018) A network analysis of eating disorder symptoms and characteristics in an inpatient sample. Psychiatry Res 262:270–281. https://doi.org/10.1016/j.psychres.2018.02.027
Panero M, Marzola E, Tamarin T, et al (2021) Comparison between inpatients with anorexia nervosa with and without major depressive disorder: clinical characteristics and outcome. Psychiatry Res 297. https://doi.org/10.1016/J.PSYCHRES.2021.113734
Peebles R, Lesser A, Park CC, et al (2017) Outcomes of an inpatient medical nutritional rehabilitation protocol in children and adolescents with eating disorders. J Eat Disord 5. https://doi.org/10.1186/S40337-017-0134-6
Preis MA, Schlegel K, Stoll L et al (2020) Improving emotion recognition in anorexia nervosa: an experimental proof-of-concept study. Int J Eat Disord 53:945–953. https://doi.org/10.1002/eat.23276
Rizzo SM, Douglas JW, Lawrence JC (2019) Enteral nutrition via nasogastric tube for refeeding patients with anorexia nervosa: a systematic review. Nutr Clin Pract 34:359–370
Robinson P, Jones WR (2018) MARSIPAN: management of really sick patients with anorexia nervosa. BJPsych Adv 24:20–32. https://doi.org/10.1192/BJA.2017.2
Royal College of Psychiatrists (2014) MARSIPAN: management of really sick patients with anorexia nervosa, 2nd edn CR189
Schlegl S, Quadflieg N, Löwe B, et al (2014) Specialized inpatient treatment of adult anorexia nervosa: effectiveness and clinical significance of changes. BMC Psychiatry 14. https://doi.org/10.1186/S12888-014-0258-Z
Strik Lievers L, Curt F, Wallier J et al (2009) Predictive factors of length of inpatient treatment in anorexia nervosa. Eur Child Adolesc Psychiatry 18:75–84. https://doi.org/10.1007/S00787-008-0706-8
Treasure J, Oyeleye O, Bonin EM et al (2021) Optimising care pathways for adult anorexia nervosa. What is the evidence to guide the provision of high-quality, cost-effective services? Eur Eat Disord Rev 29:306–315. https://doi.org/10.1002/ERV.2821
Waples L, Giombini L, Wiseman M, Nesbitt S (2021) Psychological changes in young people with anorexia nervosa during an inpatient treatment: exploration of optimal length of stay predictors. Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater. https://doi.org/10.1007/S40211-021-00390-0
Yager J, Michael Devlin CJ, Halmi KA, et al (2010) Practice guideline for the treatment of patients with eating disorders third edition work group on eating disorders American psychiatric association steering committee on practice guidelines area and component liaisons staff
Zipfel S, Sammet I, Rapps N et al (2006) Gastrointestinal disturbances in eating disorders: clinical and neurobiological aspects. Auton Neurosci Basic Clin 129:99–106. https://doi.org/10.1016/J.AUTNEU.2006.07.023
Zuchova S, Erler T, Papezova H (2013) Group cognitive remediation therapy for adult anorexia nervosa inpatients: first experiences. Eat Weight Disord 18:269–273. https://doi.org/10.1007/S40519-013-0041-Z
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Martini, M., Lepora, M., Longo, P., Amodeo, L., Marzola, E., Abbate-Daga, G. (2022). Anorexia Nervosa in the Acute Hospitalization Setting. In: Patel, V., Preedy, V. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-67929-3_35-1
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