Climbing Mount Everest: Tips for C-L Psychiatrists Managing Patients with Anorexia Nervosa on The Medical Unit

Abstract: Background/Significance: The prevalence of anorexia nervosa (AN) has drastically increased in the face of the COVID-19 pandemic (Schwartz et al 2021, Goldberg et al. 2022), resulting in increased number of presentations of malnourished AN patient on general medical units. The AN population is one of the most difficult to manage in a medical setting, due to both patient factors, such as ambivalence towards recovery and behaviors that interfere with weight gain, as well as systemic barriers, such as the lack of structured containment and consistent staffing for patient supervision. There is a significant need for increased eating disorders expertise in CL psychiatry as we continue to support our medical colleagues in the treatment of these patients.

Methods: The Toronto General Hospital (TGH) at the University of Toronto has been creating a pathway where CL psychiatrists closely consult with colleagues working in the TGH eating disorders program for challenging cases, with the goal of developing a consistent future treatment approach for individuals presenting with anorexia nervosa on a medical unit. Key challenges from clinical cases were identified and targeted as areas for education and improvement.

Results: Major challenges from past clinical cases of AN requiring consultation are described. Themes include difficulty with finding of incapacity for these patients, ongoing eating disorders symptoms during the process of refeeding, inconsistent staff approaches, and poor weight gain and prolonged hospitalizations. Important lessons learned and recommendations for future practice are discussed. Promotion of rapid weight gain via multiple measures, consistent limit setting and a united approach to patient care by all members of the multidisciplinary team were identified as key elements to the successful treatment of anorexia patients. Features that would support a clinical finding of incapacity are also discussed.

Conclusion/Implications: Barriers to successful treatment of AN patients on inpatient medical settings are highlighted, and effective treatment approaches to these patients are discussed by sharing insights from the collaborative pathway between CL psychiatry and the eating disorder program created at the Toronto General Hospital.



References:

1. Schwartz MD., Costello KL. Eating disorder in teens during the COVID-19 pandemic. Journal of adolescent health. 2021 (68): 1020-1023.

2. Goldberg L., Ziv A., Vardi Y., Hadas S., Zuobi T., Yeshareem L., Gur T., Steinling S., Scheuerman O., Levinsky Y. The effect of COVID-19 pandemic on hospitalization and disease characteristics of adolescents with anorexia nervosa. European journal of pediatrics 2022 Jan (3): 1-5.