Child health- Eating disorders

Question 1

diagnostic criteria for anorexia nervosa (ICD-10)

Answer 1

deliberately keeping weight below the 85% of expected
- restricted dietary choice
- excessive exercise
- induced vomiting, use of appetite suppressants and diuretics

scared of being fat
- intrusive overvalued idea

endocrine effects
- menstruation stops or delayed if menarche not yet reached
- in men can manifest as loss of sexual interest/potency

Question 2

epidemiology of anorexia nervosa

Answer 2

lifetime prevalence of AN in women ~2-4%

incidence rates
-4.2-12.6 per 100,00 person years for females
-1 per 100,000 in males
-highest incidence is reported in people aged 15-19

AN has a higher mortality rate than any other mental health disorder

Question 3

aetiology and risk factors of AN

Answer 3

• social pressure
  -perfectionist character traits
  -reversing or halting effects of puberty

family
-attitudes to food in family to food and body shape
-refusing food as a way of being heard in families

-some genetic links
-depression may be a trigger for binges

Question 4

aetiology of AN

Answer 4

-low self esteem
- occupation and interests (ballet)
- anxiety disorders
past or present events
- life difficulties
- abuse
- physical illness
- upsetting events - death ot break up
- important events (moving away, changes)

Question 5

diagnosing AN
Screening for eating problems

Answer 5

SCOFF

Sickness- do you make yourself sick
Control- do you worry about control over eating
One stone- have you lost more than 6 kilograms in three months
Fat- belief of being fat when others say you are thin
Food- does food dominate your life?

Question 6

diagnosing AN
history

Answer 6

over valuation of body shape (delusion)

weight- intense fear of becoming fat

active maintenance of low body weight <85% of expected weight

Amenorrhea in post pubertal females

Question 7

clinical signs of AN

Answer 7

dry skin

lanugo hair- baby hair

orange skin and palms- hypercarotenaemia
may be due either to increased carotene and vitamin A intake or an acquired defect in the utilization or metabolism of vitamin A

cold hands and feet

bradycardia

drop in blood pressure on standing

oedema

week proximal muscles

Question 8

CAMHS assessment and MDT

Answer 8

Multidisciplinary assessment:
◦ Psychiatrist
◦ Psychologist
◦ Family therapist
◦ Paediatrician
◦ Dietician
Decision about whether to treat in the
community or as an inpatient

Question 9

general principles of treatment for disordered eating

Answer 9

outpatient setting ideally, unless physical health concerns- stabilise in ward, tier 4 (inpatient CAMHS unit) for psychological input and monitoring (MEED guidance)

psychological

weight gain

medical - physical health monitoring and medication

Question 10

weight restoration aims

Answer 10

0.5 kg /week in outpatients
0.5-1kg /week in inpatients

feeding against the patients will possible under MHA, but requires expertise

Question 11

psychological treatments for ED

Answer 11

Cognitive analytic therapy (CAT)

Cognitive behaviour therapy (CBT),

Interpersonal psychotherapy (IPT),

Focal psychodynamic therapy

Family therapy(especially important in children)

Used in both community and inpatient settings

Question 12

medications for ED

Answer 12

Multivitamins, thiamine, phosphate may be required

Antidepressants for low mood and/or OCD symptoms (mood often improves as weight increases)

Olanzapine for agitation and anxiety, some evidence that it may promote weight gain

Quetiapine has also been used