Mental Health

Question 1

Why is mental health dietetics important?

Answer 1

15-20 year shorter life expectancy for someone with severe mental health

3x more likely to have diabetes

2x more likely to have diabetes

Biggest health inequalities from a younger age

Question 2

How are mental health patients screened?

Answer 2

• MUST tool
• SANSI (St Andrews Healthcare Nutrition Screening Instrument)
• Positive cardiometabolic health resource (intervention framework for ppl with schizophrenia/psychosis)

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Question 3

How can severe mental illness impact weight management?

Answer 3

• Obesogenic environment
• medications
• stigma
• self neglect/self harm

Question 4

What are the physical changes that occur during puberty and how can they impact mental health/nutritional status?

Answer 4

Growth:
- Increased nutrient requirements
- Increased appetite
- Weight gain

Body shape:
- Body image concerns

Physical activity levels:
- Weight loss or gain

Menstruation:
- Increased iron requirements
- PMT increased appetite
- Comfort eating

Sleep pattern:
- Skipping breakfast
- Eating later at night

Question 5

What are the psychosocial changes that occur during adolescence and how can they impact mental health/nutritional status?

Answer 5

Development of independent skills:
- Cooking/preparing food for self

Peer vs family relationships:
- More meals eaten outside home

Influence of social media/adverts:
- Fad diets
- Less healthy food choices
- Disordered eating
- Unrealistic expectations

Development of sexual/gender identity:
- Dietary manipulation to alter body weight/shape/size

Body image and self-esteem:
- Dieting
- Comfort eating
- Eating disorders

Development of beliefs and values:
Vegetarianism/veganism

Question 6

Discuss MEED guidelines (2022)

Answer 6

Medical emergencies in eating disorders (2022)

• All age guidance
• All eating disorder diagnoses

Aims to eliminate preventable deaths

Includes a practical risk assessment tool and summary sheets for different clinical groups (including dietitians)

Question 7

Discuss risk factors for refeeding syndrome:

Answer 7

Risk factors:
- Very low BMI (<13) or <70% mBMI (children/adolescents)
- Weight loss >15% in last 3 months
- Minimal/no intake for >3-4 days
- Abnormal electrolytes
- Low WBC count <3.8
- Medical co-morbidity/complications before commencing refeeding (e.g. serious infection, cardiac disease, liver disease, alcohol misuse, any evidence of acute inflammatory response)

Question 8

What are the appropriate rates of refeeding for adults and children?

Answer 8

No patient should be started on a lower kcal intake than they were having prior to admission

Adults:

Low/medium risk of RFS:
- start at 30-35kcals/kg/day.
High risk of RFS:
start at 10-20kcals/kg/day.
Increase by 5kcal/kg/day every 2 days until intake ≈ 60kcal/kg/day & weight gain >0.5kg/week.

Children/young people:

Start at 1400-2000kcals/day.
Increase by 200kcals/day until intake ≈2400kcals.

Question 9

How is refeeding syndrome managed?

Answer 9

Limit carbohydrate intake during early stages of refeeding.

Encourage foods/fluids rich in phosphate (e.g. milk, yogurt)

Daily blood monitoring for days 1-5 of refeeding in patients at high risk of RFS. Repeat at 7-10 days in case of delayed refeeding syndrome.

Most patients at high risk of RFS should be managed in an acute medical environment.

Once/twice weekly blood monitoring for patients at low/medium risk of RFS, including those being fed in the community.