Eating Disorders

Question 1

Anorexia nervosa Ix

Answer 1

Exam: wt, height, lanugo hair, BP, squat test
Bloods;
-Low: ESR, Hb, Plt, WCC, Na, K, Ph, T4
- high: GH, cortisol, cholesterol, LFT
ECG: brady, arrhythmia, prolonged QT
DEXA: ?osteoporosis (>2y Hx)
Rating scale: eating attitudes test 
NB up to 10% mortality

Question 2

Conservative Mx anorexia nervosa

Answer 2

Engagement
Psychoeduation (health and nutrition)
Treat comorbid psych illness
Nutritional management and weight restoration (0-5-1kg/wk, eating plan)
Motivational interviewing (engages ambivalent pts)
Interpersonal therapy

Question 3

Psychotherapy anorexia nervosa 1st line

Answer 3

CBT-ED
- addresses control low SE, perfectionism up 40 sessions (40 wks)
Specialist Supportive Clinical Management
- 20+ wkly sessions, explore main causes, offer education, and real life support
Maudsley AN Treatment for adults
- 20 sessions w/practitioner, helps pt understand cause
Offer any

Question 4

Psychotherapy anorexia nervosa 2nd line

Answer 4

Eating disorder focused focal psychodynamic therapy

or Adolescent focused psychotherapy

Question 5

Children w/anorexia nervosa

Answer 5

1st Line: family therapy
- some whole family, some separate
18-20/1yr
r/v 4wks after treatment, then every 3m

Question 6

Medical Mx of anorexia nervosa

Answer 6

Important if phys. condition, rapid wt loss, BMI <13.5
Inpt. may be necessary if:
BMI <13 or extremely rapid wt loss
serious physical Cx
high suicide risk
mental health act for compulsory feeding

Question 7

Refeeding syndrome?

Answer 7

Intracellular shift of ions from turning on CHO metabolism
LOW: Ph, Mg, K, thiamine, Na, water retention
Features: fatigue, weakness, confusion, high BP, seizure, arrhythmia, HF

Question 8

Referral pathways for anorexia nervosa

Answer 8

SEVERE: urgent to CEDS (BMI <15, rapid wt loss, evidence of system failure)
Mod: routine referral CEDS (BMI 15-17, no evidence system failure)
Mild: monitor/support 8wks recommend help from BEAT, routine referral to CEDS if fails
(BMI >17, no aditional comorb)

Question 9

PACES counselling AN

Answer 9

Morbid fear of fatness, reduced calorie intake, hormonal dysfunction, based on numbers not opinion
Risks: osteoporosis, infertility, arrythmia
Mx: CBT-ED, SSCM, MANTRA, Family therapy
- exploring thought processes, set plan
?medical therapy if depresssed
Support: BEAT

Question 10

Bulimia Nervosa Ix + initial Mx

Answer 10

Exam: wt, height, lanugo hair, BP, squat test
Bloods + UDS
ECG
Rating scale: Eating attitudes test
Treat medical Cx
? Bulimia focused guided self help (if ineffective after  4wks, consider individual CBT)
Children: family therapy
SSRI: fluox
Treat comorbidity

Question 11

Referral for bulimia nervosa

Answer 11

Severe: urgent CEDS (daily purging, significant electrolyte imbalance, comorb.)
Moderate: Monitor/advise 8wks, recommend self help, consider SSRI, routine referral to CEDS if failure to respond (frequent binge and purge (>2/wk), no sig. electrolyte imbalance, some medical consequences eg chest pain
Mild: recommend self help, BEAT, monitor for 4m, routine referral CEDS if no improvement/worsening

Question 12

Binge eating disorder

Answer 12

offer BED focussed self help
If unacceptable/ineffective after 4wk consider group CBT
if unacceptable/ineffective try individual CBT