Patients with Anorexia Nervosa can be a particularly challenging patient group. Though not an unommon condition, unless you are practising in a specialist centre most of us will not encounter such patients frequently. In addition to what can be a devastating psychiatric illness, these patients can become medically very unwell.
Historically there was evidence that these patients were deteriorating (and even dying) as hospital inpatients. For this reason the MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) guideline was developed.
Junior MARSIPAN is a further development from this to assist specifically with the management of anorexic patients under 18.
Guideline: CR168. Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa
The Junior MARSIPAN report provides guidance and recommendations on:
Risk assessment, physical examination and associated action.
Location of care and transition between services.
Paediatric admission and local protocols.
Management of re-feeding
Management of compensatory behaviours associated with an eating disorder in a paediatric setting.
Management in primary care and paediatric out-patient settings.
Discharge from paediatric settings.
Management in specialist CAMHS in-patient settings.
Though of course not a substitute for expert advice, this can sometimes be difficult to access in an acute situation, and a this guidance gives an excellent framework for initial assessment and informs discussion with specialist services.
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MARSIPAN is a great way to understand how to deal with adolescents and young people that might be suffering from an eating disorder. Be aware of the medical difficulties they face not only the fact that they will need CAMHS support as any other of our patients this young people need someone that will listen to them and their needs in these difficult times for them and their families.