What distinguish patients with compulsory treatment for severely undernourished anorexia nervosa

Abstract

Objective Anorexia nervosa (AN) is a mental disorder potentially leading to severe malnutrition and life‐threatening complications, with high mortality rates and dropouts from treatment. In the most severe cases, treatment refusal associated with acute nutritional disorders may require compulsory admission in specialised units. The aim of this study was to investigate clinical and nutritional parameters associated with the use of compulsory treatment for severely ill AN patients requiring intensive nutritional care. Methods This retrospective, single‐centre study performed in a unit of specialised nutritional care compared severely undernourished inpatients, compulsorily admitted for AN, with a population of sex‐ and age‐matched voluntarily admitted patients. Socio‐demographic and clinical variables were collected for univariate comparison and logistic regression. Results Compulsory treatment in AN was mainly associated with lower socio‐economic status (p < 0.01), history of lower weight (p < 0.05), more frequently prescribed psychotropic medication (p = 0.02), more previous admissions for AN, longer hospitalisations (p < 0.01) and binge eating/purging subtype (p = 0.02). Binge eating/purging subtype and the number of past admissions showed the strongest odds of compulsory treatment in multivariate analysis. Conclusion The knowledge of factors associated with compulsory treatment may help practitioners of all fields to better evaluate its pertinence and indications in AN.

Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators

“…This finding is in direct contrast with previous work which has argued that duration of illness is a key severity indicator ( Maguire et al., 2012 ). On the other hand, this is in line with previous findings linking binge-purge behaviours and low affect with treatment resistance in severe AN ( Smith and Woodside, 2021 ; Di Lodovico et al., 2021 ). Interestingly, despite one cluster reporting more binge-purge behaviours than the other, the two clusters did not differ in the proportion of individuals with AN binge-purge diagnosis.…”

International comparison of physicians’ attitudes toward refusal of treatment by patients with anorexia nervosa: a case-based vignette study

“…Thus, the physicians may have respected the patient's self-determination. Furthermore, even if a life-threatening AN crisis is averted for patients with severe and enduring disease, the crisis is likely to recur [30]. This may be a reason why some respondents in the present study considered involuntary treatment futile from a long-term perspective.…”

Involuntary treatment in patients with anorexia nervosa: utilization patterns and associated factors

“…Having parents with a low educational level may indicate a more challenged background and a more generally complex life situation. However, higher SES measured using fathers' occupation has been found to be positively associated with IT in AN in a study with a rather small sample size (Griffiths et al, 1997), whereas patients with IT have been found to have lower SES measured by employment status (Di Lodovico et al, 2021). Nevertheless, the two results indicate that social setting influences IT in complex ways that require further explication.…”

“…Nasogastric tube feeding and involuntary admission have typically been the specific IT measures studied in patients with AN (Clausen & Jones, 2014) with a few recent studies addressing restraint use (Blikshavn et al, 2020; Clausen et al, 2018) – an IT experienced as particularly distressing to psychiatric patients (Akther et al, 2019; Seed, Fox, & Berry, 2016a, 2016b; Tingleff, Bradley, Gildberg, Munksgaard, & Hounsgaard, 2017). Factors associated with IT use in AN include psychiatric comorbidity and symptom level, previous hospital admissions, early and late onset, longer illness duration, lower IQ, self-harm, history of physical or sexual abuse, lower and higher socioeconomic status (SES), longer treatment duration, and AN symptom severity (Atti et al, 2021; Clausen & Jones, 2014; Clausen et al, 2018; Di Lodovico et al, 2021; Elzakkers, Danner, Hoek, Schmidt, & van Elburg, 2014; Griffiths, Beumont, Russell, Touyz, & Moore, 1997; Zohar-Beja, Latzer, Adatto, & Gur, 2015). Furthermore, previous admissions, older age at first diagnosis, and psychiatric comorbidity have been found to predict the first IT event (Clausen et al, 2018).…”