因严重限制性进食障碍而住院的患者的医学和精神特征。

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-07-01 DOI:10.1016/j.jaclp.2024.02.001
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引用次数: 0

摘要

背景:严重进食和进食障碍患者因其疾病固有的并发症经常需要住院治疗,但有关这种护理的正规培训却很有限:这项回顾性研究纳入了2018年至2021年期间在医疗稳定病房住院的545名严重神经性厌食症(AN)或回避性限制性食物摄入障碍(ARFID)患者。住院期间全程采集生物计量学数据。增加营养,直到患者每天增加 0.2 千克:入院时平均体重指数(BMI)为 13 kg/m2,诊断结果为:46% AN-R(限制型)、39% AN-BP(暴饮暴食型)和 15% ARFID。出院时,女性的日均热量为 3,343 千卡,男性为 3,962 千卡;26% 的患者需要鼻饲。低血糖在第 7 天之前很常见,与肝功能检测(LFT)升高和低白蛋白有关。31% 的患者 LFT 异常。从第 2 天开始,26% 的患者出现再喂养性低磷血症,并与较低的体重指数有关。39%的患者在入院时出现低钾血症,是确诊为 AN-BP 患者的两倍。50%的患者初始心电图异常,通常为窦性心动过缓。平均 QTc 正常,只有 14% 的患者 QTc 延长。骨密度检测显示,70%的患者患有骨质疏松症。19%的患者有自杀企图,76%和50%的患者分别患有焦虑症和抑郁症:鉴于严重进食和喂养障碍的医疗并发症是不可分割的,CL 精神科医生熟悉经常观察到的异常结果的发生率可以为咨询提供参考,防止不良事件和不必要的干预,促进体重恢复和医疗稳定。
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Medical and Psychiatric Characteristics of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder

Background

People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited.

Methods

This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization. Nutrition was increased until patients were gaining 0.2 kg/day.

Results

Average admission body mass index was 13 kg/m2 with diagnoses of 46% AN-R (restricting), 39% AN-BP (binge-purge), and 15% avoidant restrictive food intake disorder. Average daily Kcals by discharge were 3343 for females and 3962 for males; 26% required nasogastric feeding. Hypoglycemia was common until day 7, correlated with elevated liver function tests and low prealbumin. Liver function tests were abnormal in 31% of patients. Refeeding hypophosphatemia developed in 26% of patients starting day 2 and was associated with lower body mass index. Hypokalemia appeared on admission among 39%, twice as common in patients diagnosed with AN-BP. Initial electrocardiograms were abnormal in 50% of patients, usually sinus bradycardia. Average QTc was normal, but only 14% prolonged. Bone density testing revealed 70% osteoporosis. History of suicide attempts were present in 19%, while 76% and 50% presented with anxiety and depressive disorders, respectively.

Conclusions

Given the inextricability of medical complications from severe eating and feeding disorders, familiarity among consult-liaison psychiatrists with the prevalence of frequently observed abnormal findings can inform consultation, prevent adverse events, prevent unnecessary intervention, and facilitate weight restoration and medical stabilization.

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来源期刊
CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
期刊最新文献
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