10 Part I Since my first days in Medical School, I have been fascinated by the relationship between body and mind. During my residency in psychiatry, I got aware of the gap between psychiatric and medical care, both in terms of physical healthcare facilities and in terms of treatment approaches. This gap leads to inadequate care or even dangerous situations and increased mortality for patients with both psychiatric and medical problems. Fortunately, the need for more integrated care was recognized in the healthcare community, leading to the emergence of medical-psychiatric units (MPUs). I was lucky to have been given the opportunity to start an MPU at the Amsterdam UMC, location AMC and have been working there as a hospital psychiatrist ever since. Though fascinated and intellectually stimulated by the diagnostics and treatment of a broad range of intertwined psychiatric and somatic conditions, there is one disorder that stands out for me because of its intriguing clinical picture, the pervasiveness of the condition, the severity of comorbidities and its potential devastating outcome, and that is anorexia nervosa (AN). ANOREXIA NERVOSA AN is a severe mental health condition characterized by an intense fear of gaining weight and a distorted body image that leads to restricted food intake and other behaviors leading to a failure to maintain a minimally normal body weight. Patients often are in a state of denial with regard to their own low body weight and its adverse impact on their health (1). The condition can have devastating effects on multiple organ systems, leading to severe medical complications such as cardiac complications, electrolyte imbalances, osteoporosis, and even death. Beyond the physical consequences, AN also has significant psychological and emotional impact, affecting relationships, academic or work performance, and overall quality of life (2). AN has one of the highest mortality rates (crude mortality rate (CMR) 5.1 deaths per 1000 person-years (95% CI 4.0–6.1), standardized mortality rate (SMR) 5.9 (95% CI 4.2–8.3) among psychiatric conditions (3). The risk of death is significantly increased through both physical complications and an elevated risk of suicide. Treatment options for AN consist of psychological treatments such as cognitive behavioral therapy for eating disorders (CBT-E), family-based therapy (FBT) and nutritional rehabilitation. Psychopharmacological agents can be used to treat underlying mood and thought disorders, but are generally considered less effective than psychological treatment (4). Specialized eating disorder units and eating disorders expert health care professionals are often limited, there are long waiting lists, and require a stabilized medical condition. Medical units often lack the psychiatric expertise to provide and establish nutritional habilitation. The integrated care for severely compromised patients with AN can be provided at some MPUs. However, overall, the severity of AN cannot be overstated. Its complex, multi-systemic impact, the high mortality and the scarcity
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