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Anorexie mentale prise en charge - Summary Anorexia nervosa - Levels of care

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Mis en ligne le 30 sept. 2010 Ces recommandations de bonne pratique ont pour objectif d’aider à : repérer plus précocement l’anorexie mentale ;améliorer l’accompagnement du patient et de son entourage ;améliorer la prise en charge et l’orientation initiale des patients ;améliorer la prise en charge hospitalière lorsqu’elle est nécessaire et la prise en charge post-hospitalière.Sont concernés : les préadolescents, les adolescents et les jeunes adultes.Les axes prioritaires d’amélioration de la qualité des soins définis pour ce travail sont les suivants :repérage et diagnostic précoces, prenant en compte les populations les plus à risque, les signes d’alerte et les critères diagnostiques les plus pertinents, ainsi que la recherche d’alliance avec le patient et son entourage, souvent difficile du fait des mécanismes de déni ;modalités d’orientation et de prise en charge ambulatoire des patients (adressage, nécessaire pluridisciplinarité et dispositifs spécialisés, en particulier en termes d’hospitalisation de jour) ;indications et modalités d’hospitalisation à temps plein (critères de gravité, contrats thérapeutiques et place de l’hospitalisation sous contrainte).L’élaboration de ces recommandations de bonne pratique résulte d’un partenariat entre la HAS et l’Association française pour le développement des approches spécialisées des troubles du comportement alimentaire (AFDAS-TCA), et répond également à une demande de la Direction générale de la santé. Mis en ligne le 30 sept. 2010

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Published 30 September 2010
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Language English
With the methodological partnership  and the financial support of
 
 
With the partnership of
With the participation of
SUMMARY OF PRACTICE GUIDELINES
Anorexia nervosa: management 2 - Initial specialist care and management pathways
June 2010
 LEVELS OF CARE Depending on the circumstances and the seriousness of the condition, patients can be managed as outpatients (with variable intensity of care), and/or as inpatients.
Patients should initially be managed as outpatients, unless there is a physical or psychiatric emergency.
Attention should be given to the consistency and continuity of care throughout the stages of management and between the various people involved. In particular, if the patient is admitted to hospital: · inpatient care should be followed on immediately by outpatient care, either sequentially or transitionally in a day unit, or at the very least in the form of outpatient appointments, because patients do not leave the hospital fully cured; · the care team responsible for the admission should ensure that previous outpatient care continues, or they should organise new multidisciplinary follow-up. In order to do this, telephone contact should be made during th e hospitalisation, and information meetings between current and future care teams are essential. It is also necessary that the discharge summary be distributed rapidly. The patient and
his/her family must be included in the organisation of care.     
MULTIDISCIPLINARY MANAGEMENT 
OUTPATIENT 
People involved The primary care physician organises multidisciplinary outpatient care once the 1 diagnosis is confirmed, while respecting the therapeutic alliance .
Care should be provided by a team of at least two healthcare professionals, which would usually include the following: ·  because of the logist,a psychiatrist or paediatric psychiatrist or psycho psychological effects and common psychiatric comorbidities of this disease; ·  practitioner ora physician, who can be the primary care physician (general paediatrician), if he/she is prepared to take on the responsibility.                                                      1 A therapeutic alliance is something that is created gradually over time together with the patient and his/her family, and involves an empathetic, genuine, warm and professional attitude.