Hospital admission and treatment of patients with anorexia nervosa: guidelines and recommendations


This Canadian rapid response report will be of interest to anyone looking for a general introduction to the high level evidence relating to hospital admission and the treatment of patients with anorexia nervosa.

The authors found 1 meta-analysis, 2 systematic reviews and 3 guidelines, but no health technology assessments.

They summarised their findings as follows:

  1. One meta-analysis and two systematic reviews sought to evaluate the literature pertaining to the effectiveness of treatments for anorexia nervosa. A limitation of these studies is the uncertainty that the patients in the included studies were hospital inpatients.
    1. The meta-analysis did not find strong evidence for a particular psychological therapy or procedure, or treatment setting, although inpatient treatment may produce faster weight gain than outpatient treatment.
    2. One systematic review discussed the effectiveness and safety of various interventions for anorexia nervosa, including anxiolytic drugs, cyproheptadine, inpatient/outpatient treatment setting, estrogen treatment, psychotherapy, refeeding, selective serotonin reuptake inhibitors, and tricyclic antidepressants.
    3. One systematic review concluded that the evidence for the treatment of anorexia nervosa is weak after evaluating studies including medications and behavioural therapy.
  2. One guideline recommends that adult patients who weigh less than approximately 85% of their individually estimated healthy weight would benefit from a highly structured program, including inpatient care. Inpatient care is also recommended (with substantial clinical confidence) for some patients who are above 85% of their individually estimated healthy weight but present with other factors.
    1. The guideline recommends with substantial clinical confidence that hospitalisation should occur prior to the onset of medical instability as manifested by abnormalities in vital signs, physical findings, or laboratory tests.
    2. The guideline also states that inpatient medical treatment for children and adolescents should be considered even if they do not meet the adult criteria for hospitalisation.
    3. Treatments specific to anorexia nervosa discussed in this guideline include nutritional rehabilitation, psychosocial interventions, and medications and other somatic treatments.
  3. One guideline recommends that patients with anorexia nervosa whose disorder has not improved with outpatient treatment must be referred to day patient treatment or inpatient treatment.
    1. Inpatient management is indicated for patients who present a high risk of suicide or serious self-inflicted injuries and should be considered for patients with anorexia nervosa whose disorder is associated with high or moderate risk due to common disease or physical complications of anorexia nervosa.
    2. Recommendations pertaining to various treatment strategies for anorexia nervosa, including renutrition, nutritional counselling, family therapy, psychological therapy, and pharmacological treatment are provided.
  4. One guideline provides criteria for hospital admission for individuals with general eating disorders. General treatment and management strategies are discussed for inpatients with eating disorders.
    1. The guideline recommends that selective serotonin re-uptake inhibitors (SSRIs) may be beneficial in the non-acute stage of anorexia nervosa.

Further details of the references can be found in the full report:

Admission and Treatment of Patients with Anorexia: Guidelines and Recommendations (PDF). Canadian Agency for Drugs and Technologies in Health, 2nd November 2011.

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