NEDA TOOLKIT for Parents
The decision about whether a patient should be
hospitalized on a psychiatric versus a general medical
or adolescent/ pediatric unit should be made based on
the patient’s general medical and psychiatric status,
the skills and abilities of local psychiatric and general
medical staff, and the availability of suitable programs
to care for the patient’s general medical and
psychiatric problems [I]. There is evidence to suggest
that patients with eating disorders have better
outcomes when treated on inpatient units specializing
in the treatment of these disorders than when treated
in general inpatient settings where staff lack expertise
and experience in treating eating disorders [II].
Outcomes from partial hospitalization programs that
specialize in eating disorders are highly correlated
with treatment intensity. The more successful
programs involve patients in treatment at least 5
days/week for 8 hours/day; thus, it is recommended
that partial hospitalization programs be structured to
provide at least this level of care [I].
Patients who are considerably below their healthy
body weight and are highly motivated to adhere to
treatment, have cooperative families, and have a brief
symptom duration may benefit from treatment in
outpatient settings, but only if they are carefully
monitored and if they and their families understand
that a more restrictive setting may be necessary if
persistent progress is not evident in a few weeks [II].
Careful monitoring includes at least weekly (and often
two to three times a week) weight determinations
done directly after the patient voids and while the
patient is wearing the same class of garment (e.g.,
hospital gown, standard exercise clothing) [I]. In
patients who purge, it is important to routinely
monitor serum electrolytes [I]. Urine specific gravity,
orthostatic vital signs, and oral temperatures may
need to be measured on a regular basis [II].
In an outpatient setting, patients can remain with their
families and continue to attend school or work.
Inpatient care may interfere with family, school, and
work obligations; however, it is important to give
priority to the safe and adequate treatment of a
rapidly progressing or otherwise unresponsive
disorder for which hospital care might be necessary [I].
3. Choice of Specific Treatments for Anorexia
Nervosa The aims of treating anorexia nervosa are to 1) restore
patients to a healthy weight (associated with the
return of menses and normal ovulation in female
patients, normal sexual drive and hormone levels in
male patients, and normal physical and sexual growth
and development in children and adolescents); 2) treat
physical complications; 3) enhance patients’
motivation to cooperate in the restoration of healthy
eating patterns and participate in treatment; 4)
provide education regarding healthy nutrition and
eating patterns; 5) help patients reassess and change
core dysfunctional cognitions, attitudes, motives,
conflicts, and feelings related to the eating disorder; 6)
treat associated psychiatric conditions, including
deficits in mood and impulse regulation and self-
esteem and behavioral problems; 7) enlist family
support and provide family counseling and therapy
where appropriate; and 8) prevent relapse.
a. Nutritional Rehabilitation
The goals of nutritional rehabilitation for seriously
underweight patients are to restore weight, normalize
eating patterns, achieve normal perceptions of hunger
and satiety, and correct biological and psychological
sequelae of malnutrition [I]. For patients age 20 years
and younger, an individually appropriate range for
expected weight and goals for weight and height may
be determined by considering measurements and
clinical factors, including current weight, bone age
estimated from wrist x-rays and nomograms,
menstrual history (in adolescents with secondary
amenorrhea), mid-parental heights, assessments of
skeletal frame, and benchmarks from Centers for
Disease Control and Prevention (CDC) growth charts
(available at http://www.cdc.gov/growthcharts/) [I].
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