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Acute Care Hospitalization
Please note: Eating disorders develop in men, women, girls, and boys. For ease in reading, we have used "she" and "her" in the text below.
Inpatient treatment is appropriate when a patient’s safety is at risk:
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 Heart rate: < 40 beats per minute for adults. For children and adolescents, <50 b.p.m. during the day and < 45 b.p.m. at night.
- Blood pressure: <90/60 mmHg for adults and <80/50 mmHg for children and adolescents
- Orthostatic BP Changes: > 20 b.p.m. rise in HR or > 10 mmHg fall in BP
- Body temperature: < 97 degrees Fahrenheit
- Dehydration
- Electrolyte imbalance
- Severe depression, suicidality
- Weight :< 85% of healthy body weight generally. Rapid weight loss may indicate hospitalization even if weight is not <85%.
- A rapid weight drop in an adolescent or child with an eating disorder may be an indication for hospitalization even if the amount of weight lost is not extreme. Children who do not take in enough food or fluid are quite vulnerable to dehydration and -- in comparison to adult patients -- may be at risk of medical compromise from a proportionately smaller decline in weight.
- Patient cannot modify abnormal eating habits without staff support during and after meals. Severe, frequent purging may necessitate hospitalization even if lab tests show no significant problems.
Inpatient Services
Inpatient care, which generally lasts from several days to a couple of months, focuses on medical monitoring and management of complications resulting from the eating disorder. Whether the patient is admitted to a medical or psychiatric unit is highly individualized. Based on the results of periodic laboratory testing, intravenous fluids may be needed to stabilize the patient’s electrolytes.
Inpatients who are underweight work with a registered dietitian to restore their nutritional health. Many have pursued thinness at all cost and feel unduly anxious about ingesting foods that they consider “unsafe.” A key component of hospital programs is positive reinforcement for progress toward healthy behaviors.
One-on-one psychotherapy offers the patient empathy and helps motivate her to participate in her program. Nursing staff is instrumental in supporting and encouraging individuals during meals and snacks. Some hospital units provide group therapy sessions, giving patients opportunities to share their feelings with each other and with staff. Family education-support groups are often available as well.
Discharge planning is based not on weight status alone, but rather on a combination of variables, including how motivated the patient is to follow her nutrition program. Individuals discharged to outpatient care after gaining weight in the hospital may be at risk of relapse if they have not made emotional progress in support of recovery.
References
Practice guideline for the treatment of patients with eating disorders
American Psychiatric Association (APA). Practice guideline for the treatment of patients with eating disorders. 3rd ed. Washington (DC): American Psychiatric Association ; 2006 Jun. 128 p. [765 references].
Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa
Bewell, C.V., Carter, J.C. Readiness to change mediates the impact of eating disorder symptomatology on treatment outcome in anorexia nervosa. International Journal of Eating Disorders. 2008; 41: 368-71.
The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up
Bowers, W.A., Ansher, L.S. The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Annals of Clinical Psychiatry. 2008; 20: 79-86.
The effect of bed rest on bone turnover in young women hospitalized for anorexia nervosa: a pilot study
DiVasta, A.D., Feldman, H.A., Quach, A.E., Balestrino, M., Gordon, C.M. The effect of bed rest on bone turnover in young women hospitalized for anorexia nervosa: a pilot study. Journal of Clinical Endocrinology and Metabolism. 2009; 94: 1650-5.
Clinicians' perspectives on the premature termination of treatment in patients with eating disorders
Masson, P.C., Sheeshka, J.D. Clinicians' perspectives on the premature termination of treatment in patients with eating disorders. Eating Disorders. 2009; 17: 109-25.
Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment
Rothschild, L., Lacoua, L., Stein, D. Changes in implicit and explicit measures of ego functions and distress among two eating disorder subgroups: outcomes of integrative treatment. Eating Disorders. 2009; 17: 242-59.
Predictive factors of length of inpatient treatment in anorexia nervosa
Strik Lievers, L., Curt, F., Wallier, J., Perdereau, F., Rein, Z., Jeammet, P., Godart, N. Predictive factors of length of inpatient treatment in anorexia nervosa. European Child & Adolescent Psychiatry. 2009; 18: 75-84.
Motivational change in an inpatient anorexia nervosa population and implications for treatment
Wade, T.D., Frayne, A., Edwards, S.A., Robertson, T., Gilchrist, P. Motivational change in an inpatient anorexia nervosa population and implications for treatment. Australian and New Zealand Journal of Psychiatry. 2009; 43: 235-43.
Dropout from inpatient treatment for anorexia nervosa: Critical review of the literature
Wallier, J., Vibert, S., Berthoz, S., Huas, C., Hubert, T., Godart, N. Dropout from inpatient treatment for anorexia nervosa: Critical review of the literature. International Journal of Eating Disorders. (In press).
Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial
Zeeck, A., Weber, S., Sandholz, A., Wetzler-Burmeister, E., Wirsching, M., Hartmann, A. Inpatient versus day clinic treatment for bulimia nervosa: a randomized trial. Psychotherapy and Psychosomatics. 2009; 78: 152-60.
Photograph of stethoscope by apox®, Flickr.com Creative Commons
This page was last updated on September 27, 2009.
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