title: First results of a refeeding program in a psychiatric intensive care unit for patients with extreme anorexia nervosa.
abstract: BACKGROUND
  Anorexia nervosa (AN) is associated with a high mortality rate. This study describes a compulsory re-feeding program established in Munich for extremely underweight patients.
  
  
  METHODS
  The contract between the patient and the therapeutic team included mandatory inpatient status, establishment of guardianship and compulsory re-feeding with a percutaneous gastric feeding tube, as indicated. The predefined target was a body mass index (BMI) of 17 kg/m(2). Data on the first 68 patients with AN are presented.
  
  
  RESULTS
  65 (95.6%) patients were female and mean age at admission was 26.5 ± 8.5 years. BMI increased from 12.3 ± 1.4 kg/m(2) at admission to 16.7 ± 1.7 kg/m(2) at discharge. Thirty-two (47.1%) patients had the restrictive subtype (ANR) and 36 (52.9%) had the binging and purging subtype (ANBP). Duration of illness before admission (p = .004), days of treatment until discharge (p = .001) and weight increase (p = .02) were significantly different between subgroups in favor of patients with ANR. Also, seasonal differences could be found. Comparison of feeding methods showed that percutaneous tube feeding was superior. Almost half of the patients were treated with psychotropic medication. To date, however, the number of patients included in this program is too small to assess rare complications of this acute treatment program and long term outcomes of AN.
  
  
  CONCLUSIONS
  An intensive care program for severely ill AN patients has been successfully established. Besides averting physical harm in the short term, this program was designed to enable these patients to participate in more sophisticated psychotherapeutic programs afterwards. To our knowledge, this is the first such program that regularly uses percutaneous feeding tubes.
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. christoph.born@med.uni-muenchen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Born
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. larissa.fontaine@med.uni-muenchen.de.
authors.forename: Larissa
authors.initials: L
authors.lastname: de la Fontaine
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. bwinter@tridoc-consulting.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Winter
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. norbert.mueller@med.uni-muenchen.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Müller
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. aschaub@med.uni-muenchen.de.
authors.forename: Annette
authors.initials: A
authors.lastname: Schaub
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. clemens.fruestueck@med.uni-muenchen.de.
authors.forename: Clemens
authors.initials: C
authors.lastname: Früstück
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. cornelius.schuele@med.uni-muenchen.de.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Schüle
authors.affiliation: Schoen-Klinik Roseneck, Prien am Chiemsee, Germany. uvoderholzer@schoen-kliniken.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Voderholzer
authors.affiliation: Schoen-Klinik Roseneck, Prien am Chiemsee, Germany. ucuntz@schoen-kliniken.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Cuntz
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. peter.falkai@med.uni-muenchen.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Falkai
authors.affiliation: Department of Psychiatry, Ludwig Maximilians-University, Nussbaumstrasse. 7, 80336, Munich, Germany. eva.meisenzahl@med.uni-muenchen.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Meisenzahl
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology