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:
- 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.
- 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.
- 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.
- One systematic review concluded that the evidence for the treatment of anorexia nervosa is weak after evaluating studies including medications and behavioural therapy.
- 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.
- 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.
- 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.
- Treatments specific to anorexia nervosa discussed in this guideline include nutritional rehabilitation, psychosocial interventions, and medications and other somatic treatments.
- 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.
- 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.
- Recommendations pertaining to various treatment strategies for anorexia nervosa, including renutrition, nutritional counselling, family therapy, psychological therapy, and pharmacological treatment are provided.
- 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.
- 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.