Inpatient Eating Disorder Unit Research Articles

Reduction of adverse events in a psychiatric inpatient eating disorder unit during the COVID-19 pandemic.

Globally, the COVID-19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered. This paper aimed to understand if pandemic-related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents. An exploratory study design was used to examine incidence of aggression, self-harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted. Analyses revealed a complete reduction in episodes of self-harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF. Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery-oriented service delivery for adolescents with eating disorders in inpatient settings.

Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Using Music Breathing to Support Emotion Regulation for Patients in an Inpatient Eating Disorders Unit: A Mixed-method Pilot Study

The prevalence of eating disorders (EDs) is increasing, and a growing number of patients with EDs are seeking professional help. Some studies have utilized modifications of the Bonny Method of Guided Imagery and Music (GIM) in various stages of ED treatments for individuals and groups, and this is the first Music Breathing research focusing on inpatient eating disorders recovery. This pilot study describes the process and aspects of utilizing a short series of Music Breathing sessions in an inpatient eating disorder setting to promote emotion regulation. The article describes the mixed-method results at the inpatient unit at the UNC Center of Excellence for Eating Disorders during the COVID-19 pandemic.

Improving mealtimes for patients and staff within an eating disorder unit: the next chapter

ObjectivesMealtimes are an integral part of treatment for patients in an eating disorder inpatient unit. However, they are often distressing and anxiety provoking for both patients and staff. A consequence...

Early career mental health nurses' emotional experiences in specialist eating disorder units, Victoria, Australia.

The treatment of consumers with eating disorders requires skilled clinicians due to the psychological and medical complexities of the illness. However, a volume of research shows that clinicians report negative feelings, such as anxiety, frustration and anger when providing care for consumers with eating disorders. Limited research explores mental health nurses' experiences working in a specialist eating disorder inpatient unit. This study aimed to explore early career mental health nurses' experiences working in such a unit in Australia. A descriptive qualitative method was used, incorporating a stage of theoretical analysis informed by psychodynamic concepts. A total of six nurses were interviewed. Two key themes emerged: (i) initial tension; (ii) understanding self and others through countertransference. In the first theme, participants commonly reported anxiety and frustration. Frustration often related to the struggle to empathise and feeling powerless to change life-threatening eating behaviours. The second theme explored the understanding of self and others through countertransference. Participants described the inadequacy, anger and anxiety they felt during the interaction with consumers as the projection of another person's inner experience. Nurses' accounts also reflected identification of self to others, in the attempt to understand experiences of consumers. The phenomenon of re-enactment of pre-existing relationships was also raised. The study shows that working with consumers with eating disorders can elicit strong emotional experiences, which early career nurses were able to over time to more usefully explore as countertransference. It is recommended that nurses have appropriate opportunities to discuss and reflect on their feelings in order to develop their practice and professional resilience.

Writing through the pandemic and paediatrics

As I sit down to write this Saturday morning, I’m exhausted. Last night, I admitted four adolescents and young adults for medical stabilisation in the inpatient eating disorders unit in San Francisco (CA, USA). But my weekend ritual begins with a silver lining of the pandemic: a community of health-care workers who gather on Zoom for an hour of focused writing. The Medicine and the Muse programme at Stanford University sponsors this series, “Writing Medicine”, and Laurel Braitman, an author and writing professor, facilitates the sessions.

An analysis of outcome measures in a specialist inpatient eating disorders unit in Aberdeen: changes since 2015 and response to the COVID-19 lockdown

AimsIdentify differences in outcome measures between inpatient cohorts during the first year of the pandemic compared with preceding years.Identify key elements in the treatment provided by identifying any trends in the outcome measures between 2015 and 2021.BackgroundThe Eden Unit at the Royal Cornhill Hospital (RCH) in Aberdeen is a ten-bed specialist centre for the inpatient treatment of eating disorders (ED). Strict measures to control the spread of COVID-19 have meant that important aspects of therapy in the Eden Unit are no longer permissible. It is not known whether handicaps to providing the previous service are reflected in recent outcomes.MethodValues for age, length of stay (LOS), BMI, HbA1c (diabetic patients) and responses to three questionnaires: Eating Disorder Evaluation Questionnaire (EDE-Q); Depression Anxiety Stress Scale (DASS)-21; and Clinical Outcomes in Routine Evaluation (CORE). This data were collected for April 2020 to February 2021 (Pandemic) and compared with five preceding years, April 2015 to March 2020 (Pre-COVID). The project was registered with NHS Grampian Quality Assurance Team and approved by the MCN Quality Assurance subgroup. Ethical approval was not required. A data collection sheet allowed anonymised data to be entered into a Microsoft Excel TM Spreadsheet for analysis of baseline demographics.ResultAverage age of patients remained similar across the six years. Length of stay in the first year of the pandemic was significantly shortened. BMI on discharge in 2020/21 remained similar to preceding years. If relevant, HbA1c was measured throughout admission and comparison with BMI change reflected a focus on treating both diabetes and ED concurrently. Comparison of admission and discharge questionnaires to determine outcome measures proved difficult due to the small number of responses to both.ConclusionShorter LOS during the pandemic was a significant finding. Despite this, BMI on discharge remained similar, suggesting a shift to weight restoration due to lack of opportunities for an holistic approach due to restrictions. Key elements of treatment include careful monitoring of HbA1c and concurrent management of Type I Diabetes for those patients. The low response rate to questionnaires raises concern regarding their use, in their current format, as effective tools to measure outcomes. Though low numbers of questionnaire responses prevent firm conclusion, it appears that the reduced opportunities for elements of treatment to be undertaken in the community may have contributed to increased anxiety levels on discharge.

Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic—an initial report

BackgroundMealtimes occur six times a day on eating disorder (ED) inpatient units and are a mainstay of treatment for EDs. However, these are often distressing and anxiety provoking times for...

Retrospective analysis of hypophosphatemia rates and other clinical parameters in patients with eating disorders.

To retrospectively assess medical services of a specialist inpatient eating disorders (EDs) unit. We retrospectively evaluated clinical parameters of 288 inpatients classified as 'moderately' or 'significantly' medically compromised between 1 January 2016 and 30 June 2019. We analysed 288 patients (mean age 32.5 [SD = 11.4] years, 96% women, 76% with anorexia nervosa). Average length of stay was 38.4 (SD = 28.4) days. Average admission body mass index (BMI) was 14.8 (SD = 1.8) kg/m2 , and 16.1 (SD = 1.9) kg/m2 at 4 weeks. At admission, 82% of patients were considered significantly medically compromised, while 6% were deemed moderately compromised. Only 5% of patients required transfer to intensive care unit. Prevalence of hypophosphatemia was 17.7%; rates did not increase significantly between years despite more assertive re-feeding processes. There was no association between risk classification at admission and change in BMI at 4 weeks (F(2,166) = 0.588, p = 0.557). BMI at admission was found to be significantly associated with clinical outcome (β = 0.92, p < 0.001). Hypophosphatemia rates did not increase despite more assertive re-feeding over 3 years. Our results provide support for a model of treatment that simultaneously addresses the medical and psychiatric sequelae of patients with severe EDs.

Use of Stimulants in Patients with Comorbid Anorexia Nervosa and Attention-Deficit/Hyperactivity Disorder in a Structured Inpatient Setting.

Clinicians may be concerned about using psychostimulant medications in patients in whom weight gain is desired because of their potential side effects of appetite suppression and weight loss. This report depicts the successful treatment of 2 adolescent patients with anorexia nervosa (AN) and attention-deficit/hyperactivity disorder (ADHD) in an inpatient eating disorders unit. A report of 2 clinical cases (ages 19 and 20 years) was used to describe the management of comorbid AN and ADHD. Tolerance to stimulants, meal completion, and ability to restore weight were assessed over the course of hospitalization. Behaviorally focused refeeding combined with psychostimulants notably improved symptoms of AN and comorbid ADHD without adverse effects. Psychostimulant medications may be used successfully in patients with AN and ADHD in the context of structured behavioral treatment designed for weight restoration.

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

BackgroundStudies of the use and effects of physical restraint in anorexia nervosa (AN) treatment are lacking. The purpose of this study was to describe the frequency of physical restraint in a specialized program for adolescents with AN, and to examine if meal-related physical restraint (forced nasogastric tube-feeding) was related to 5-year outcome.MethodThirty-eight (66% of 58) patients with AN (mean age 15.9, SD = 1.9) admitted to a regional, specialized adolescent eating disorders (ED) inpatient unit. Patient data, including restraint episodes, were obtained from hospital records, and outcome was assessed at a 5-year follow-up.ResultsA total of 201 restraint episodes occurred over 5513 days of inpatient treatment, including 109 meal-related episodes and 56 episodes to avoid self-harm. Twelve (32%) patients experienced at least one restraint episode during the admission, of which eight (21%) experienced meal-related restraint. Four patients represented 91% of all restraint episodes, experiencing 10 or more episodes during admission. Meal-related restraint was significantly associated with a higher rate of persisting ED diagnosis, but not with weight gain during admission, EDE-Q global score or BMI at follow-up.ConclusionsRestraint episodes occurred rather infrequently. A small number of patients (n = 4) accounted for a high proportion of episodes (91%). More knowledge is important to reduce the need for restraint in treatment for AN.

Metabolic Predictors of Length of Stay on an Eating Disorder Inpatient Unit

Anorexia nervosa, characterized by extreme food restriction and a body weight that is less then minimally expected, can require multiple inpatient hospitalizations for medical stabilization and enduring recovery. Building on observed genetic correlations between anorexia and metabolic parameters, we examined whether metabolic factors predict inpatient length of stay.

Psychic room to breathe. Themes emerging within a staff Balint group on an eating disorder inpatient unit

Anorexia nervosa is the psychiatric disorder with the highest mortality rate. Anorexic patients admitted to inpatient eating disorder units are often critically unwell in both their physical and mental health. Underpinning working with these patients is a real feeling that they are close to death. Staff, and particularly nurses, in eating disorder units may find working with anorexic patients extremely challenging. It has been documented that working with such patients can give rise to strong and difficult to process countertransference feelings and reactions. The authors of this paper introduced a Balint group for the staff on an eating disorder inpatient ward to provide a space for the team to reflect on the work. This paper reports on the experience of running this Balint group and describes the themes that gradually emerged. These are then discussed and related to the nature of the disorder and the particular challenges of working with this inpatient population.

An evaluation of a manualised group self-esteem programme for Anorexia Nervosa patients regaining weight

Low self-esteem has been identified as a strong predictor of onset, maintenance and relapse in eating disorders. This suggests that treatment directly addressing low self-esteem might improve recovery. The Cognitive Behavioural Therapy (CBT) based group for low self-esteem is a six session manualised programme based on Melanie Fennel’s model for low self-esteem. It was developed at Newbridge House, a child and adolescent eating disorder inpatient unit in the UK. Although the use of CBT for low self-esteem is established in adult services, the Newbridge programme, adapting the same principles for children and adolescents, is to our knowledge, the first of its kind. This paper reports a service evaluation (N=63) which examines the efficacy of this group in improving low self-esteem for 12-17 year olds with a primary diagnosis of Anorexia Nervosa (AN). Paired-samples t-tests compared the differences in pre- to post-group and post-group to follow-up. Results indicate significant improvements in self-esteem as shown by improvements on the Rosenberg Self-Esteem scale, which are maintained at follow-up. This highlights that group manualised CBT for low self-esteem is effective for young people with AN and indicates the need for future controlled studies.

FACTIOUS DISORDER MASQUERADING AS IDIOPATHIC ANAPHYLAXIS

Introduction Idiopathic anaphylaxis is a diagnosis of exclusion with a broad differential. We present a patient with multiple ICU admissions in a two-month period treated as anaphylaxis but without supportive objective findings. Case Description A 14-year old female presented with subjective lip angioedema and stridor concerning for anaphylaxis, without a known trigger. Subsequently, she was admitted to an inpatient eating disorder unit given newly discovered significant weight loss. During her hospitalization, 6 codes were called for anaphylaxis resulting in 5 ICU admissions and 1 elective intubation given persistent stridor despite optimal treatment. These episodes consisted of subjective lip swelling with pursing and stridor which coughing resolved. Patient was treated as idiopathic anaphylaxis after reassuring evaluation of other etiologies. She began a long-term prednisone course for frequent idiopathic anaphylaxis which was not effective. When it was noted her episodes occurred with progress in her treatment, she received a diagnosis of factious disorder. With psychiatric treatment, her anaphylactoid episodes resolved. Discussion This case demonstrates the need to consider non-organic causes in the differential diagnoses of idiopathic anaphylaxis. The patient's symptoms were viewed by providers as anaphylaxis and thus were treated without meeting NIAD criteria on several occasions. [1, 2] Ultimately, her symptoms were most consistent with factious disorder. Prior reports have discussed patients with symptoms consistent with anaphylaxis but who do not respond to treatment and whose symptoms are found to be non-organic. [3, 4] These patients can be difficult to manage and respond best to treatments for their underlying psychiatric diseases.

Feasibility and acceptability of the Bod Pod procedure and changes in body composition from admission to discharge in adolescents hospitalized with eating disorders.

The feasibility and acceptability of using the Bod Pod procedure to measure changes in body composition in 30 adolescent females admitted to an inpatient eating disorder unit was evaluated using written surveys, Bod Pod measurements obtained at admission and discharge, and medical records review. Participants rated the Bod Pod test as acceptable (100%; 30/30), comfortable (93%, 28/30), and they were willing to repeat the procedure (97%, 29/30). Ten participants did not complete the final Bod Pod: eight were discharged before a second measure could be obtained, one refused the test, and one left against medical advice. Three participants had undetectable readings at admission. Paired t-tests (n = 17) revealed a significant (p < 0.001) mean increase in fat mass (3.7 ± 2 kg), body fat percentage (6.6 ± 3.8%), and lean mass (1.4 ± 1.2 kg) from admission to discharge. The Bod Pod is a feasible and acceptable procedure to measure changes in body composition in adolescent females hospitalized with an eating disorder.

\u201cDo you see what I mean?\u201d staff collaboration in eating disorder units during mealtimes

BackgroundEating disorders are psychiatric illnesses with potentially life-threatening consequences. Inpatient treatment is typically required for the most severely ill patients, who are often emaciated or significantly malnourished. A core therapeutic objective is to normalize eating patterns and facilitate weight gain. These goals guide the efforts of milieu therapeutic staff working with this patient group, who support renourishment through the positive manipulation of a structured environment, as well via relational aspects. However, there is a lack of empirical research exploring inpatient staff members’ perspectives concerning various aspects of this work. This article explore staff’s teamwork during mealtimes on inpatient eating disorder units. Specifically, we investigated the collaborative strategies employed to support core therapeutic goals of meal completion and normalized eating behavior, while concurrently maintaining a supportive, friendly atmosphere during mealtimes.MethodsThis was a exploratory qualitative study. Data was collected through 20 semi-structured in-depth interviews with staff members working on a specialized eating disorder unit. The interviews were performed after the conduction of meal time support. Cultural historical activity theory was used as the key theoretical tool for analysis.ResultsThe analysis revealed three main themes: 1) strategic seating arrangements mediates division of labor, 2) the use of verbal and nonverbal communication as collaborative tools, and 3) the importance of experience as a collaborative resource.ConclusionsThe present study found that mealtime collaborative strategies on inpatient EDUs were mainly of non-verbal nature, with level of experience as an important premise for staff collaboration. Greater awareness about how collegial collaboration is practiced may help staff members to learn routines and regulate scripts for mealtime practices.

Self-admission to in-patient treatment: Patient experiences of a novel approach in the treatment of severe eating disorders

IntroductionThe course of an eating disorder is often prolonged and can lead to enduring disability for many years, with some patients requiring lengthy periods of in-patient care. Unfortunately, there is still little evidence concerning the optimal model of in-patient care for these patients.ObjectivesSelf-admission is a novel treatment tool, whereby patients who have high health care utilization are offered the possibility to self-admit to an inpatient ward for up to seven days, because of deteriorating mental health or any other reason. Purposes behind the model are to increase the availability of in-patient care, to promote autonomy and agency, and to decrease total inpatient care utilization.AimsTo investigate whether self-admission can be beneficial for patients with severe eating disorders.MethodsTwo beds out of eleven at a specialist eating disorders inpatient unit were reserved for self-admission of well-known patients. All participants were interviewed about their experiences in the program at 6 months.ResultsParticipants described an increased sense of agency and safety in their everyday lives. Suggestions were also made, such as a more active outreach approach in promoting admission, providing a continual staff contact during the brief admission episode, and offering a similar self-admission model for day treatment.ConclusionsSelf-admission is a viable tool in the treatment of severe eating disorders and can increase quality of life by providing a safety net and promoting agency. However, logistical obstacles must be addressed in order to promote a constructive use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

To bend or not to bend? Rule adherence among staff at an eating disorder unit

ABSTRACTOn inpatient eating disorder units, resolving under-nutrition and reestablishing normal eating behavior are key treatment aims. Consequently, the provision of support at mealtimes is a core work task for patients with severe eating disorders. The purpose of this study was to explore staff deliberations and actions, as observed during staff-patient interactions at mealtimes on an inpatient eating disorder unit (EDU). We specifically aimed to characterize how and why staff members intervene during staff-patient interactions in which a refeeding script is activated. This exploratory qualitative study combined non-participant observation and in-depth interviews. Content analysis was used to categorize and abstract the data material. Through the described analysis, we identified two main types of patterns which were categorized as rule adherence and rule bending, describing how staff chose how to intervene in situations where refeeding scripts were activated. The current findings may contribute to enhanced insight and awareness regarding staff behavior and deliberations when providing meal support, and thus help staff members to better understand how meal time support is practiced on inpatient EDUs.

Structured, supported feeding admissions for restrictive eating disorders on paediatric wards

BackgroundRestrictive eating disorders in young people are increasingly requiring admission to the hospital and can be a challenge to manage on acute general paediatric wards.MethodsWe have developed a joint working...