Eating Disorders Flashcards
(10 cards)
Anorexia nervosa psychotherapies
CBT-ED
- Usually up to 40 sessions over 40 weeks
- Encourages healthy eating
- Addresses nutrition, cognitive restructuring and self esteem
Maudsley Anorexia Nervosa Treatment in Adults (MANTRA)
- Offer 20 or more weekly sessions
- Explore the main problems that cause anorexia
- Educate about nutrition and how eating habits cause
symptoms
- Also explore other aspects of management (e.g. improving relationships, getting back to work)
Specialist Supportive Clinical Management (SSCM)
- Offer 20 sessions with a practitioner
- Helps the patient understand the cause of their anorexia (focuses on what is important to the patient) and encourages the person to develop a ‘non-anorexic identity’
If any of the above options are unacceptable, offer a different one of the three or consider Eating Disorder-Focused Focal Psychodynamic Therapy (FPT)
Anorexia nervosa medical treatment
Particularly important if there are physical complications, rapid weight loss or BMI < 13.5
Anorexia nervosa inpatient treatment
May be necessary if:
- BMI < 13 or extremely rapid weight loss
- Serious physical complications
- High suicide risk
- Mental Health Act may be needed to enable compulsory feeding
Refeeding syndrome
Caused by an intracellular shift of ions due to switching to carbohydrate metabolism
Biochemical Features: low phosphate, low magnesium, low potassium, low thiamine, salt and water retention
Clinical Features: fatigue, weakness, confusion, high blood pressure, seizures, arrhythmia, heart failure
Anorexia nervosa in children
1st line: Family Therapy
- Some sessions should be for the whole family and others should be separate
- Usually, 18-20 sessions over 1 year
- Review 4 weeks after treatment, then every 3 months
2nd line: if Family Therapy unacceptable, consider Individual CBT-ED or AFP-AN
Up to 10% will die because of anorexia
Bulimia nervosa management
Bulimia nervosa is a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.
Consider Bulimia Nervosa-Focused Guided Self-Help Programme for adults
Children: offer family therapy (FT-BN)
CBT-ED with nutrition and meal support
SSRIs (Fluoxetine) or SNRI
- Reduce bingeing and purging by enhancing impulse control
- Should not be offered as sole treatment for bulimia
Treat comorbid psychiatric illness
- Depression, self-harm and substance misuse are common
Anorexia nervosa referral
Severe - Urgent referral to CEDS (community eating disorder service)
- Features: BMI < 15, rapid weight loss, evidence of system failure
Moderate - Routine referral to CEDS
- Features: BMI 15-17, no evidence of system failure
Mild - Monitor/advice/support for 8 weeks, recommend support from BEAT, routine
referral to CEDS if failure to respond
- Features: BMI > 17, no additional co-morbidity
Bulimia nervosa referral
Severe - Urgent referral to Community Eating Disorder Service
- Features: daily purging with significant electrolyte imbalance, comorbidity
Moderate - Monitor/advice/support for 8 weeks, recommend self-help,
consider SSRI, routine referral to CEDS if failure to respond
- Features: frequent binging and purging (>2/week), no significant electrolyte abnormality, some medical consequences (e.g. chest pain)
Mild - Recommend self-help, recommend BEAT, monitor/advice/support
for 3 months, routine referral to CEDS if no improvement/deterioration
Binge eating disorder
Offer BED focused guided self-help programmes for adults
If unacceptable or ineffective after 4 weeks, consider group CBT-ED
If unacceptable or ineffective, consider individual CBT-ED
