School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
J Acad Consult Liaison Psychiatry. 2024 Sep-Oct;65(5):458-470. doi: 10.1016/j.jaclp.2024.08.006. Epub 2024 Sep 1.
Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date.
This review aggregates available information on POI due to psychiatric conditions and provides a framework for the clinical approach to these conditions in hospitalized adult patients.
We searched PubMed and EMBASE for reviews of POI due to psychiatric causes, but no relevant publications were identified. Diagnostic criteria for relevant conditions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and Rome IV were reviewed, as were C-L psychiatry textbooks and relevant society websites. This review was further supplemented by a case conference at the authors' institution.
We have divided results into five sections for clinical utility: (1) the need to rule out medical causes of POI; (2) unpleasant somatic experiences, including psychotropic causes; (3) mood, psychotic, catatonic, and neurocognitive disorders that can present with POI; (4) eating and feeding disorders; and (5) personal and interpersonal explanations of POI. Within each section, we review how to identify and manage each condition, specifically considering the effects of treatment on oral intake.
The clinical management of POI varies based on cause. For instance, psychostimulants can cause POI due to inappetence; however, they can treat POI due to abulia by improving motivation. The fact that such a broad range of psychiatric conditions can cause POI calls for a systematic clinical approach that considers the categories of potential causes. We also identified a need for prospective studies focused on the management of POI due to psychiatric conditions, as the literature on this topic is limited to case reports, case series, and retrospective cohort studies.
内科和外科住院患者的不良口腔摄入（POI）可导致营养不良和恢复延迟，这是由于医疗后果和对更具侵入性营养支持的需求所致。许多精神疾病可导致 POI；然而，迄今为止，精神疾病在 POI 中的作用受到的关注有限。
本综述汇总了由于精神疾病导致 POI 的现有信息，并为住院成年患者这些疾病的临床处理方法提供了框架。
我们在 PubMed 和 EMBASE 中搜索了有关精神原因导致 POI 的综述，但未发现相关出版物。我们查阅了《精神障碍诊断与统计手册》第五版文本修订版和罗马 IV 中相关疾病的诊断标准，以及 C-L 精神病学教科书和相关学会网站。本综述还通过作者机构的病例会议进行了补充。
我们将结果分为五个部分用于临床实用：（1）需要排除 POI 的医学原因；（2）不愉快的躯体体验，包括精神原因；（3）可能出现 POI 的情绪、精神病性、紧张性和神经认知障碍；（4）进食和喂养障碍；以及（5）POI 的个人和人际解释。在每个部分中，我们都回顾了如何识别和管理每种疾病，特别是考虑了治疗对口腔摄入的影响。
POI 的临床管理因病因而异。例如，精神兴奋剂可因食欲不振而导致 POI；然而，它们可通过改善动机来治疗因意志缺失而导致的 POI。如此广泛的精神疾病可导致 POI，这需要一种系统的临床方法，考虑潜在病因的类别。我们还发现需要针对精神疾病引起的 POI 管理进行前瞻性研究，因为该主题的文献仅限于病例报告、病例系列和回顾性队列研究。
