Risk stratification

Not all patients require admission, some can be well managed in the community. It is important to consider the trajectory of the eating disorder, any recent stresses or escalated behaviours, support networks that are available, and what may be achieved by admission at this time.

That said, patients with eating disorders can appear deceptively well and it is important to have a low threshold to consider admission.

Those patient who should be admitted include:

• Patients at high risk from their eating disorder. These patients may require admission to a psychiatric unit. The Mental Health Act 1983 (amended 2007) allows for compulsory admission and treatment.
• Patients with another psychiatric disturbance such as self-harm or suicidal ideation will need a mental health review with a view to possible admission.
• Patients with physical complications may require admission if medically unstable. The Royal College of Psychiatrists (RCPSYCH) have produced the MARSIPAN guidelines, to assist clinicians assessing patients with eating disorders.

MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa

For patients under 18yrs the Junior MARSIPAN guidelines provide a detailed traffic light system to aid risk assessment. There is also a Junior MARSIPAN app which contains a quick risk assessment tool and percentage median BMI calculator.

Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa

Table 1: Summary of high-risk factors which indicate admission for medical input may be required.