Acute medical stabilisation of adults with anorexia nervosa: experience of a defined interdisciplinary model of care.

BACKGROUND: Patients with anorexia nervosa (AN) are vulnerable to physiological decompensation and often require inpatient management by an eating disorders unit. AIMS: Patients admitted to an Australian tertiary medical centre for medical stabilisation of AN were assessed as part of quality assurance. Analysis included: (i) medical complications during acute inpatient stabilisation; (ii) predictors of refeeding syndrome; (iii) predictors governing length of stay (LOS); and (iv) outcomes pre- and post-implementation of multidisciplinary treatment guidelines. METHODS: A retrosepctive analysis of 95 consecutive admissions (60 individual patients) between November 2011 and August 2017 was performed. RESULTS: Patients had a median LOS of 9.6 days (interquartile range 5.8-19.7) and a mean weight gain of 1.4 kg (standard deviation 2.9). Medical complications included the following: hypoglycaemia (11.6%) and refeeding electrolyte derangement (26.3%). Advancing age (odds ratio (OR) 1.06 per year, P = 0.019), nasogastric tube requirement (OR 3.4, P = 0.014) and Code Grey(s) (security calls) (OR 7.1, P = 0.010) were associated with refeeding electrolyte derangement. Parameters associated with increased LOS included the following: lower body mass index (P = 0.029), Code Grey(s) (P = 0.029) and tachycardia (P = 0.013). Following multivariate analysis, the post-guidelines implementation group required less intravenous fluid and electrolyte replacement, though had lower rates of refeeding electrolyte derangement (OR 0.33 (0.11-0.99)). CONCLUSION: Patients with moderate to severe AN are at risk of dangerous medical complications, and older patients may have heightened predisposition to refeeding electrolyte derangement. Early identification of medically high-risk patients is imperative to implement timely, life-saving interventions.

Body mass index as a screening test for metabolic syndrome in schizophrenia and schizoaffective disorders.

OBJECTIVE: The aim of this paper was to identify a simple screening measure for detecting metabolic syndrome (MetS) in people with schizophrenia and schizoaffective disorders. METHOD: A total of 202 patients with chronic schizophrenia and schizoaffective disorders on antipsychotic medications were assessed for MetS using the criteria defined by the International Diabetes Federation. Receiver operating characteristic (ROC) analysis was applied using body mass index (BMI) as the test variable for diagnosis of MetS. RESULTS: The prevalence of MetS was 69.3%. Logistic regression analysis identified BMI and gender as significant predictors of MetS. ROC analysis identified BMI >28.7 as the criterion value with highest accuracy in terms of specificity and sensitivity. The likelihood ratios were robust at this cut-off score. The area under the curve was 0.75. CONCLUSION: BMI is a quick and easy measure, and can be used as a screening test for MetS in any clinical or community setting.

Obesity and metabolic syndrome in a psychiatric rehabilitation service.

OBJECTIVE: People with schizophrenia and bipolar disorders suffer from increased rates of obesity and metabolic syndrome. Metabolic disorders add to the burden of disease and affect treatment and rehabilitation outcomes. This study aimed to study the prevalence of obesity and metabolic syndrome in people with chronic psychotic disorders in a psychiatric rehabilitation setting. METHOD: All patients in the psychiatry rehabilitation program were assessed for obesity and metabolic syndrome using the definition of International Diabetes Federation (2005) was conducted as part of clinical protocol recently introduced into practice. RESULTS: A total of 221 patients were assessed. The prevalence of obesity was 59% and metabolic syndrome 68%. Metabolic syndrome was more frequent in patients receiving polypharmacy with multiple antipsychotics and mood stabilisers. Rates of nontreatment for metabolic disorders ranged from 30% to 88%. CONCLUSIONS: The rates of obesity and metabolic syndrome in patients with chronic severe mental disorders on antipsychotic drug treatment were 2 to 3 times that in the general population. A majority of them were untreated. Detection, monitoring and appropriate treatment of obesity and metabolic disorders should be a component of an assertive care management program to reduce morbidity and mortality and improve rehabilitation outcomes.