[PDF] MARSIPAN: management of really sick patients with anorexia nervosa (2nd edition)

Royal College of Psychiatrists - RCPsych
Royal College of Psychiatrists;Royal College of Physicians (RCP);Royal College of Pathologists
Publication date:
01 October 2014


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 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 legislation
  • Advice for commissioners on required services for this group of very ill patients

The report updates and replacesĀ CR162: MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa, from 2010.