Eating Disorders Management

Question 1

What are the first line psychological managements of AN?

Answer 1

CBT-ED
- Up to 40 sessions 40 weeks
- Addresses nutrition, cognitive restructuring and self-esteem

Maudsley AN treatment in adults
- 20 or more weekly sessions
- Main problems that cause anorexia
- Educate about nutrition and eating habits
- Explore aspects of management (eg. improving relationships and getting back to work)

Specialist supportive clinical management
- 20 sessions
- Understand cause of anorexia and encourages to develop non-anorexic identity

Question 2

What is done if the first line psychological mx for AN are not effective?

Answer 2

Consider a different one of the first three OR

Eating disorder focused focal psychodynamic therapy

Question 2

What are the second line psychological therapies for AN?

Answer 2

• CBT-ED
• Adolescent-focused psychotherapy (AFP-AN)

Question 3

What therapy can be used as an adjunct in AN?

Answer 3

Interpersonal therapy

(Better for later onset or longer duration illness)

Question 4

When is inpatient treatment of AN necessary?

Answer 4

• BMI <13 or extremely rapid weight loss
• Serious physical complications
• High suicide risk
• MHA for compulsory feeding

Question 5

What is first line treatment for children with AN?

Answer 5

Family therapy
- Some sessions for the whole family, some separate
- 18-20 sessions over a year
- Review 4 weeks after tx and then every 3 months

Question 6

What is second line tx for children with AN?

Answer 6

AFP-AN

Question 7

What is the referral pathway for severe AN?

Answer 7

Urgent referral to CEDS (community eating disorder service)

Question 8

What is the referral pathway for moderate AN?

Answer 8

Routine referral to CEDS

Question 9

What is the referral pathway for mild AN?

Answer 9

Monitor/ advice/ support for 8 weeks, recommended support from BEAT, routine referral to CEDS if failure to respond

Question 10

What are the criteria for severe, moderate and mild AN?

Answer 10

• Severe: BMI<15, rapid weight loss, evidence of system failure
• Moderate: BMI 15-17, no evidence of system failure
• Mild: BMI<17, no additional co-morbidity

Question 11

What are the first line managements for adults with BN?

Answer 11

Mild:
- BN focused guided self help
Moderate:
- CBT-ED with nutrition and meal support
- SSRI or SNRI
- Treat comorbid psychiatric condition

Question 12

Why are SSRIs or SNRIs offered in BN?

Answer 12

• Reduce bingeing and purging by enhancing impulse control

(Not offered as a sole treatment)

Question 13

What is the referral pathway for severe BN?

Answer 13

Urgent CEDS referral

Question 14

What is the referral pathway for moderate BN?

Answer 14

Monitor/ advice/ support for 8 weeks, recommended self help, consider SSRI

Routine referral to CEDS if failure to respond

Question 15

What is the referral pathway for mild BN?

Answer 15

• Recommended self-help
• BEAT
• Monitor/ advice/ support for 3 months
• Routine referral to CEDS if failure to respond/ deterioration

Question 16

What are the criteria for severe, moderate and mild BN?

Answer 16

• Severe: Daily purging, significant electrolyte imbalance, comorbidity
• Moderate: Frequent binging and purging (>2x/week), no significant electrolyte abnormality, some medical consequences (eg. chest pain)