Eating disorders

Question 1

Main diagnostic criteria for AN

Answer 1

1. Weight <85% predicted or BMI <17.5
2. Fear of gaining weight + persistent behaviour that interferes with weight gain
3. Distorted body image

Question 2

Screening tool for EDs

Answer 2

SCOFF
Sick - do you ever make yourself sick?
Control - do you worry you've lost control over eating?
One stone - lost in 3 months?
Fat - do you believe you are fat?
Food - does food dominate your life?

Question 3

Investigations in ED

Answer 3

• height, weight, BMI
• squat test
• bloods: ESR, TFTs, FBC, U&E, phosphate, albumin, LFT, CK, glucose
• ECG
• others as indicated e.g. DEXA scan

Question 4

What rate of weight gain may be recommended?

Answer 4

0.5-1kg/week (about 3500-7000 extra kcal/week) - aiming for final BMI 20-25

Question 5

Psychological treatments for AN

Answer 5

• individual ED-focussed CBT (CBT-ED)
• Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
• specialist supportive clinical management (SSCM)
• 2nd line: ED-focussed focal psychodynamic psychotherapy
• <18s: family therapy

Question 6

Psychological drug treatment of AN

Answer 6

• fluoxetine - monitor QT interval

- olanzapine (unlicensed) - increases appetite

Question 7

Mild AN and management

Answer 7

BMI >17.5

• focus on building trusting relationship, acknowledging problem, and change
• consider ref. to secondary care if no response in 8 weeks

Question 8

Moderate AN and management

Answer 8

BMI 15-17.5, no evidence of system failure

- routine ref. to EDU or ED service

Question 9

Severe AN and management

Answer 9

BMI <15, rapid weight loss, evidence of system failure

• urgent ref. to EDU/medical unit
• refeeding may be needed

Question 10

What is refeeding syndrome

Answer 10

phosphate deficiency due to rapid initiation of food after >10 days undernutrition

Question 11

Main diagnostic criteria for BN

Answer 11

1. recurrent binge eating with uncontrolled over-eating
2. preoccupation with control of body weight
3. regular use of purging/mechanisms to overcome fattening effects of binges - PREDOMINANT feature
   (4. BMI >17.5)

Question 12

Treatment of mod-severe (or mild unresponsive) BN

Answer 12

• refer to EDU/service
• treat medical/psychiatric illness
• self-help, CBT-ED or CBT
• antidepressants - fluoxetine 60mg (higher than for depression) - enhances impulse control, reduces binges and purging