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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]. Page | 47