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The Management of Really Sick Patients with
Anorexia Nervosa (MARSIPAN) working group arose out of concerns
that a number of patients with severe anorexia nervosa were being
admitted to general medical units and sometimes deteriorating and
dying on those units because of psychiatric problems, such as
non-adherence to nutritional treatment, and medical complications,
such as re-feeding syndrome. Sometimes overzealous application of
National Institute for Health and Clinical Excellence (NICE)
guidelines led to death from underfeeding syndrome. It seems there
are also worrying variations in practice.
This report aims to clarify the situation and
provides recommendations and unambiguous guidelines on the
management of this patient group in a number of settings, in order
to help reduce the number of avoidable deaths of patients with
severe anorexia nervosa. It provides:
- Advice on physical assessment.
- Advice to the primary care team and criteria
for admission to both medical units and specialist eating disorder
units as well as non-specialist psychiatric units, and criteria for
transfer between those services.
- Advice on the required members of the
in-patient medical team.
- Medical, nutritional and psychiatric
management of patients with severe anorexia nervosa in medical
units, including the appropriate use of mental health
- Advice for commissioners on required services
for this group of very ill patients.
This is a joint report from the Royal College
of Psychiatrists, the Royal College of Physicians (London) and
the Royal College of Pathologists.
This report updates and replaces CR162:
MARSIPAN: Management of Really Sick Patients with Anorexia
Nervosa, from 2010.
- MARSIPAN working group
- Executive summary and recommendations
- Issues arising in all settings
- Management in different sectors
- Treatment of children and adolescents under
- Areas with limited local eating disorders
- Audit and review
1. Cases reported to the MARSIPAN group
2. Modified Newcastle guideline for MARSIPAN
3. Healthcare provision in UK eating disorders
4. Compulsory treatment
5. Initial low-calorie feeding rates in
6. Drug treatment during assisted
7. MARSIPAN: key points for hospital staff
8. MARSIPAN implementation in UK localities,
9. MARSIPAN implementation 2010–2014: other
10. Re-feeding in anorexia nervosa:
information for ward staff
11. Authors’ comments