This document discusses food refusal as a psychiatric emergency. It defines food refusal as refusing to eat for 3 consecutive days. Potential causes of food refusal include schizophrenia, depression, paranoia, hallucinations, hysteria, and anorexia nervosa. Complications from prolonged food refusal include electrolyte imbalances, nutritional deficiencies, worsening of psychotic symptoms, and increased risk of seizures. Treatment involves addressing the underlying psychiatric condition as well as ensuring nutrition through feeding tubes or IVs to prevent starvation. Nursing interventions include careful explanation before inserting feeding tubes or IV lines to avoid misunderstandings.

1. By:
Nasser Saad M Al-Elyani
M Al-Jehani
Nawaf Jarid

2.  Introduction
 What is emergency of food refusal.
 Causes of food refusal.
 Complications of food refusal.
 Treatment of food refusal
 Nursing intervention in
food refusal Patients.

3. Food refusal is commonly seen in hospitalized
patients with mental illness resulting in
cachexia and death if left untreated. In acute
conditions, it may lead to a medical
emergency.

4. What is food refusal as a psychiatric
emergency?
 Refusal of food is considered as psychiatric
emergency when patients refuse to eat for
3days consecutively.

5. There are 6 causes of refusal of food :
1-Schizophrenic patients: are so preoccupied
with their fantasies that they often fail to
realize a need for food.

6. 2-depressed patients: may be so overwhelmed
with feeling of guilt & inadequacy that they
really believe they are undeserving of food or
planned suicide by food
deprivation.

7. 3-paranoid patients : usually they have delusion
of persecution. Patient may believe that food
is contaminated or poisoned.
4-Hallucinating patients: patients may hear
voices that command him not to eat.

8. 5-hysterical patients: may refuse to eat in order to
gain attention.
6-patients with anorexia nervosa: they have
extreme fear from weight gain.

9. People with anorexia may have psychological and
emotional characteristics that contribute to
anorexia.
# Signs and symptoms of anorexia nervosa:
Emotional and behavioral indications
# Emotional and behavioral characteristics
associated with anorexia include:
*Refusal to eat *Denial of hunger
*Excessive exercise *Difficulty concentrating
*Flat mood, or lack of emotion

10. Refusal of food can result in electrolyte imbalance
and nutritional deficiencies and worsen
psychotic symptoms. When patients refuse to
eat, they are at risk of having a seizure due to
poor nutrition. A subsequent complication of
this could be that new psychotic symptoms
could emerge during the phases of the seizure.
Overall, the mortality rate is higher for a patient
refusing to eat and has psychiatric comorbidity

11. The effects of malnutrition :
Malnutrition affects every system causing vulnerability
to infection, poor wound healing, impaired organ
function, muscle weakness, depression and apathy.
Some of these effects are shown in the next slide .
Starvation is also accompanied by depletion of
specific electrolytes, minerals and micronutrients.
These need to be appreciated when offering care to
the malnourished.

13.  Treatment of the primary cause as psychosis or
depression should be the first step.
 Spoon feeding, tube feeding, and intravenous
feeding may have to be used to prevent starvation.
 Ethical considerations, legal issues, and social
support also come into play in the treatment of
psychiatric patients who refuse food

14. The appropriate nursing intervention will be to
insert nasogastric tube and/or I.V line
infusion after proper explanation of
procedure to avoid
misinterpretation.

15. 
https://www.psychiatry.org/

https://www.mayoclinic.org/

https://www.nimh.nih.gov/