From the Guidelines
For patients refusing to eat during hospitalization, a comprehensive psychological intervention is essential, and the initial psychiatric evaluation should include weighing the patient, quantifying eating and weight control behaviors, and identifying co-occurring health conditions, as recommended by the American Psychiatric Association 1. Begin with a thorough assessment to identify underlying causes such as depression, anxiety, eating disorders, psychosis, or medical conditions affecting appetite. Initial interventions should include:
- Establishing rapport through empathetic communication
- Setting clear nutritional goals
- Implementing behavioral strategies like meal scheduling and positive reinforcement Consultation with psychiatry is recommended for medication evaluation - consider mirtazapine (15-30mg at bedtime) for its appetite-stimulating and antidepressant properties, olanzapine (2.5-5mg daily) for psychosis or severe anxiety affecting intake, or low-dose benzodiazepines like lorazepam (0.5-1mg) for acute anxiety during meals. Nutritional consultation is crucial to determine appropriate caloric needs and potential for supplementation. For severe cases not responding to these interventions, more intensive approaches may be necessary, including nasogastric feeding or transfer to specialized eating disorder units. Throughout treatment, maintain a multidisciplinary approach involving nursing staff, physicians, psychiatry, and nutrition services, with regular team meetings to assess progress and adjust interventions as needed, as recommended by the American Psychiatric Association 1. This comprehensive approach addresses both the psychological factors and physical needs of patients refusing nutrition. Technology-based psychological interventions may also be a suitable approach for eating disorder patients, as they have been found to be effective in treating other mental disorders, and preliminary evidence suggests they may be acceptable and effective for adolescents with mental disorders 1.
From the Research
Psych Intervention for Refusal to Eat as Inpatient
There are no research papers provided that directly address psych intervention for refusal to eat as an inpatient. The studies provided focus on the effectiveness of selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) in treating obsessive-compulsive disorder (OCD), depression, and anxiety in children and adolescents.
Related Findings
- The studies suggest that SSRIs and CBT are effective treatments for OCD, depression, and anxiety in children and adolescents 2, 3, 4, 5, 6.
- CBT is associated with lower attrition rates compared to pharmacotherapy 6.
- The combination of CBT and SSRIs may produce greater improvement than either treatment alone, although the additive benefit of CBT may not be statistically significant until later in treatment 3, 4.
- Patient characteristics, such as age, sex, and baseline symptom severity, may influence treatment response 3, 4, 5.
Limitations
- The studies provided do not directly address psych intervention for refusal to eat as an inpatient.
- The findings may not be generalizable to other populations or treatment settings.
- Further research is needed to determine the effectiveness of psych interventions for refusal to eat as an inpatient.