厭食症與再餵食症候群的住院治療

Inpatient Treatment of Anorexia Nervosa and Refeeding Syndrome

前言：厭食症為一精神病理複雜且具高致死率之精神疾病，常與許多其他精神疾病與身 體疾病共病。由於病人對病情的否認與治療的不配合，以及醫療專業人員缺乏對體重相關的 精神和身體狀況的認識和處理之知識，厭食症的治療一直是臨床照顧者和研究者的一大挑 戰。研究方法：本綜論回顧已發表的國內外研究文獻，論述厭食症的住院治療，再餵食症候 群，以及住院中營養復健的行為治療。結果：在精神科急性病房，透過整合型治療計畫，包 括結構性的增重計畫，內科治療其身體併發症及再餵食症候群，行為治療其異常飲食與代償 性行為，和多元跨領域團隊進行心理社會處遇等方法，可達到體重恢復，改善身體不適，和 飲食行為正常化的目的。結論：我們期待這篇綜說能增進國內精神醫療從業人員對日益增多 的厭食症個案的認識和了解。

Background: Anorexia nervosa (AN), which is a complex disorder comorbid with many mental and physical disorders, can increase morbidity and mortality. With patients’ denial and un-cooperativeness, and medical service providers’ lack of knowledge about the recognition and the management of weight-related mental and physical conditions, AN treatment has remained a challenging task for both clinicians and researchers. Methods: In this overview article, we did a comprehensive review on published English articles addressing inpatient treatment of AN and refeeding syndrome, as well as behavioral management for nutritional rehabilitation during hospitalization. Results: We found that AN patients need an integrated treatment approach practiced in psychiatric inpatient settings. An effective AN treatment including supervised weight gain program, medical management of refeeding syndrome, behavioral management of compensatory behaviors, and psychosocial interventions by multidisciplinary team may promote substantial improvements in weight restoration, alleviation of physical discomforts, and normalization of eating behaviors. Conclusion: We anticipate that this overview article would bring more awareness and recognition of the ever-increasing number of patients with AN.