Education And Debate Controversies in management

Does palliative care have a role in treatment of anorexia nervosa?We should strive to keep patients alivePalliative care does not mean giving up

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7152.195 (Published 18 July 1998) Cite this as: BMJ 1998;317:195

Does palliative care have a role in treatment of anorexia nervosa?

A recent report in a palliative care journal described a patient with longstanding and severe anorexia nervosa who was transferred from a psychiatric unit to a hospice, where she died. Williams and colleagues argue that patients with anorexia nervosa should be actively treated. Russon and Alison put the case for palliative care.

We should strive to keep patients alive

  1. Christopher J Williams (psycjw@leeds.ac.uk), senior lecturera,
  2. Lorenzo Pieri, consultantb,
  3. Andrew Sims, professor.a
  1. aDivision of Psychiatry and Behavioural Sciences in Relation to Medicine, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF,
  2. bYorkshire Centre for Eating Disorder, Seacroft Hospital, Leeds LS14 6UH
  3. Palliative care team, St James's University Hospital, Ashley Wing, Leeds LS9 7TF
  1. Correspondence to: Dr Williams

    Anorexia nervosa is defined as severe, self inflicted loss in body weight to at least 15% below that expected for the subject's sex and height. Mortality varies between 5% and 18% depending on case selection and length of follow up. A recent report described the case of a 24 year old woman who had suffered from anorexia nervosa for seven years and who was admitted for palliative care to a UK hospice in a poor physical state, received opiates, and died.1 This report concerns us for a number of reasons and raises several issues about how such cases should best be managed.

    Recovery is possible

    The goal of treatment must always be clarified when considering palliative care. In terminal illness, the decision to withdraw active treatments and provide a supportive approach to symptom control is often appropriate. We question whether this is applicable in anorexia. Recovery is possible even in patients with longstanding severe anorexia. In a 10 year follow up of 76 severely ill women with anorexia, Eckert et al found that 18 (24%) had fully recovered, about half had a benign outcome, and only five (7%) had died.2 Ratnasuriya et al found a fairly constant rate of recovery during the first 12 years after onset of illness, with reduced likelihood of recovery after this.3 In the light of these findings, we believe that the hospice admission and treatment with opiates raises important issues about the difficulties some medical and nursing staff have in dealing with chronic …

    Correspondence to: Dr Russon Lynne.Russon@st-gemma.co.uk

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