The University of Manchester Humanitarian and Conflict Response Institute, Manchester, UK.
Manchester Royal Infirmary Department of Emergency Medicine, Manchester, UK.
Postgrad Med J. 2023 May 19;99(1169):101-111. doi: 10.1136/postgradmedj-2021-140253.
Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.
与其他心理健康状况或精神科表现相比,例如在急诊科可能会看到的自残行为,饮食失调症可能相对少见。然而,它们在整个心理健康范围内的死亡率最高,存在多种医疗并发症和风险,从低血糖和电解质紊乱到心脏异常都有涉及。饮食失调症患者在看医生时可能不会透露自己的诊断。这可能是由于对疾病的否认、对可能受到重视的疾病的治疗的回避,或者是因为对心理健康的污名化。因此,他们的诊断很容易被医疗保健专业人员忽视,因此患病率被低估了。本文从一个新的视角,即结合急诊、精神科、营养和心理学的视角,向急诊和急性医学从业者介绍饮食失调症。它重点介绍了更常见表现可能发展出的最严重的急性病理;强调了隐藏疾病的指标;讨论了筛查;提出了关键的急性管理注意事项,并探讨了在一组高风险患者中处理精神能力的挑战,这些患者在接受正确治疗后可以很好地康复。