柳橋 達彦

BACKGROUND: Although oral feeding is generally preferred over parenteral nutrition during refeeding in patients with anorexia nervosa, parenteral nutrition often plays a critical role in ensuring adequate nutritional support during early refeeding and preventing underfeeding syndrome. However, few studies have examined route-specific effects on refeeding-related electrolyte deficiencies while accounting for the actual caloric intake delivered via each route. METHODS: We retrospectively examined 208 admissions from 98 patients with anorexia nervosa who were hospitalized in the psychiatric ward of Ashikaga Red Cross Hospital between January 2000 and June 2025. The mean age was 35.3 ± 11.1 years, and the mean body mass index (BMI) at admission was 12.2 ± 2.2 kg/m². In 139 of the 208 admissions (66.8%), nutrition was administered via both oral and parenteral routes. Outcome variables included serum electrolyte levels (phosphorus, potassium, magnesium, and calcium) at admission, at the in-hospital nadir, and the percent decrease from admission to nadir. Explanatory variables included caloric intake via the oral route (with a regular diet and enteral formulas analyzed separately) and the parenteral route (with dextrose and non-dextrose nutrients [amino acids and lipids] analyzed separately), electrolyte provision per calorie, BMI, and admission laboratory data. Multivariable mixed-effects regression analyses were performed. RESULTS: Caloric intake from a regular diet, enteral formulas, and parenteral non-dextrose administration was not associated with nadir electrolyte levels or with percent decreases from admission. In contrast, higher parenteral dextrose caloric intake was significantly associated with lower nadir magnesium levels (p < 0.001) and with greater percent decreases in magnesium and calcium (p < 0.001, < 0.05, respectively). Importantly, electrolyte provision per calorie via the parenteral route was not lower than that via the oral route after accounting for reported gastrointestinal absorption rates and carbohydrate proportions in each route. DISCUSSION: These findings indicate that higher parenteral dextrose administration during refeeding is associated with electrolyte decreases. This likely reflects route-specific differences in glucose handling: parenteral nutrition delivers glucose directly and rapidly into the systemic circulation, bypassing hepatic first-pass uptake that normally buffers systemic glucose and insulin exposure during oral intake. Our findings underscore the need for heightened vigilance for electrolyte deficiencies, particularly when administering parenteral dextrose.

<h4>Objective</h4>This study aimed to evaluate the dynamics of the neutrophil-to-lymphocyte ratio (NLR) during the initial hospitalization of patients with eating disorders (EDs) and to assess its potential as a biomarker for monitoring disease severity and treatment response.<h4>Methods</h4>A retrospective chart review was conducted with 55 patients aged ≤ 16 years diagnosed with anorexia nervosa or avoidant/restrictive food intake disorder and admitted to Jichi Medical University Hospital between 2015 and 2021. Sociodemographic and clinical characteristics including sex, age, rate of weight gain, percentage of ideal body weight (%IBW), tube feeding treatment, and NLR were obtained. Statistical analyses used a mixed model for repeated measures to assess NLR changes regarding %IBW and other clinical factors.<h4>Results</h4>The NLR at admission was lower in the malnourished state but increased with weight recovery. MMRM revealed that tube feeding treatment (β = 0.538) and restoration of %IBW (β = 0.029) significantly predicted an increase in the NLR. The interaction between tube feeding and the quadratic term of %IBW was also significant, indicating distinct patterns of NLR changes: without tube feeding, NLR increased linearly with weight recovery, whereas with tube feeding, NLR exhibited a non-linear, upward-convex parabolic trend.<h4>Discussion</h4>These findings suggest that NLR may offer an objective recovery marker less influenced by patient self-report. Monitoring NLR before and after tube feeding may help distinguish true physiological recovery from transient stress responses, providing complementary information to conventional assessments. Further research is warranted to establish its clinical relevance.

<h4>Purpose</h4>There is no consensus regarding the optimal target weight for discharge during the hospitalization of children with eating disorders (EDs). We attempted to identify the ideal discharge weight for children receiving their first inpatient treatment for anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID).<h4>Patients and methods</h4>Sixty children (mean age: 12.8 years) diagnosed with either AN (49 children) or ARFID (11 children) were followed for 1 year after discharge from a psychiatric ward. We analyzed the percent of ideal body weight (%IBW) at discharge, along with physical and social factors, to predict weight outcomes and rehospitalization risk during the first year after discharge. Longitudinal weight trends were assessed, and Cox proportional hazards modeling was used to analyze the time to rehospitalization.<h4>Results</h4>Single and multiple regression analyses identified the %IBW at discharge as the sole significant predictor of %IBW at 1 year. A receiver operating characteristic curve determined that 86.4%IBW at discharge was the optimal predictor of achieving 90%IBW by 1-year post-discharge. Patients who had achieved ≥ 86.4%IBW at discharge showed better weight trajectories compared with those discharged at < 86.4%IBW. A higher discharge %IBW was associated with prolonged time to rehospitalization, indicating a reduced risk of readmission.<h4>Conclusions</h4>Discharging pediatric patients at a higher weight is associated with improved weight recovery and a reduced risk of rehospitalization. A target discharge weight of 86.4%IBW may serve as an effective criterion for children with EDs.<h4>Level of evidence</h4>III, case-control analytic studies.

<h4>Background</h4>Although differential diagnosis between autoimmune encephalitis and schizophrenia spectrum disorders is crucial for a good outcome, the psychiatric symptoms that distinguish these two conditions have not been identified even though psychiatric symptoms are often the main manifestation of autoimmune encephalitis. Also, there are many situations in clinical psychiatry in which laboratory testing and imaging studies are not available. Because no comparative study of the psychiatric symptoms between these two conditions has been carried out, we explored diagnostically useful psychiatric symptoms in a retrospective case-control study.<h4>Methods</h4>We recruited 187 inpatients with first-episode psychosis who were admitted to our psychiatric unit and categorized them into two groups: the autoimmune encephalitis group (n = 10) and the schizophrenia spectrum disorders group (n = 177). Differences in the symptoms and signs between the two groups were investigated.<h4>Results</h4>Schneider's first-rank symptoms (e.g., verbal commenting hallucinations and delusional self-experience) were observed only in the schizophrenia spectrum disorders group, whereas altered perception was found more frequently in the autoimmune encephalitis group. Functional status was worse in the autoimmune encephalitis group, and neurological and neuropsychological signs were revealed almost exclusively in this group. A history of mental illness was more frequently reported in the schizophrenia spectrum disorders group than in the autoimmune encephalitis group.<h4>Conclusions</h4>The psychiatric symptoms, i.e., Schneider's first-rank symptoms and altered perception, together with neurological and neuropsychological signs, functional status, and past history, may help clinicians accurately differentiate these two conditions among patients with first-episode psychosis.