Wednesday, 9 May 2018

Eating Disorders: Co-morbidity, Assessment, Management And Treatment

Eating Disorder: Assessment, Treatment, and Management


A considerable proportion of patients with Eating Disorders have other psychiatric disorders. Most common co-morbid illness is Depression, followed by Anxiety Disorders and Personality Disorders.


However, Psychosis, OCD, and PTSD are more common in Anorexia Nervosa as compared than in other eating disorders.
Secondly, Alcohol and substance misuse are the more common in Bulimia Nervosa than in other Eating Disorder.

comorbidity, treatment, management of AN,BN and BED


 Assessment For Eating Disorder - General Points

According to a medical report the majority of patients with Eating Disorder especially BN and BED do not receive proper treatment (either patient do not seek treatment or the diagnosis is overlooked). 

Here are the few points that could help for the assessment of Eating Disorder.


  • Take a comprehensive Medical History.

  • Measure the BMI (Body Mass Index).

  • Do a general physical examination, looking for the signs and symptoms of Anorexia Nervosa and Bulimia Nervosa.

  • Do routine blood tests before initiating the treatment.

  • Do a baseline ECG.

Management of Eating Disorders - Overview

  • There are a wide variety of treatments used for Eating disorders.

  • Normalization of nutrition and eating habits is a central goal in the treatment of patients.

  • As eating disorders tend to run  a chronic course, it is important to monitor and address, on an ongoing basis:

    • Psychiatric co-morbidities.

    • Physical health complications.

    • Changes in Social circumstances.

Management of Anorexia Nervosa-
  
Depending on the availability or need patient can be treated in a :

    • Routine Psychiatry Outpatients (Adult or Child and Adolescent Services) clinic.

    • General Psychiatry Inpatient Unit.

    • General Medical Inpatient Unit.

    • Specialist Eating Disorders Inpatients/Outpatients Unit.


Pharmacotherapy for AN

Based on the research, Atypical antipsychotics (Olanzapine) and Zinc supplementation could be beneficial.

 Moreover, it is important to identify and treat any co-morbid depression and anxiety accordingly, with antidepressants.



A rationale for using Atypical Antipsychotics in AN-
  • In order to help promote weight gain(Olanzapine could be beneficial).

  • To reduce hyperactivity (used by patients as a weight losing tactic).

  • According to some evidence from neuroendocrine studies that dopamine neurotransmission is increased in AN.

So, that means Antipsychotics that have dopamine antagonist effect might be helpful.

A rationale for using Zinc in AN-

 There is a zinc deficiency in AN and zinc plays an extreme role in neurotransmitter function, it has an appetite stimulant effect also.
 According to one study, it has been found effective and beneficial that a 14 mg of elemental zinc given daily for two months(as a suggested dose).



Treatment of Bulimia Nervosa-


  • Patients are generally treated as Outpatients.

  • CBT is the treatment of choice- either Individual CBT or Group CBT

  • Other CBT Options: web-based / Telemedicine CBT, Guided Self-help, Bibliotherapy(Self-help books).

  • Interpersonal Therapy may be another helpful option.

  • Education about Healthy dieting can be helpful.


Pharmacotherapy for BN-

 SRRIs (particularly high-dose of Fluoxetine) can be helpful in reducing bingeing urges and other obsessional preoccupation with weight.


 Antiepileptic Topiramate may be helpful as it has an appetite reducing the effect.



Management of Binge Eating Disorder

Studies show that it has a high placebo response. Similar treatment approaches as for BN.

  • Psychotherapy options:

    • CBT: Individual / Group/ Online/ Self- Guided Help/ Bibliotherapy.

    • Other psychotherapies: IPT (Inter-Personal Therapy)

  • Medications:

    • SRRIs (esp. Sertraline/ Esciatalopram / Citalopram), Imipramine, Topiramate, (Sibutramine is no longer approved due to risk of MI and stroke).

  • Weight loss treatment programmes / Individual coaching, etc can be helpful with obesity.



Other helpful Treatment Options for Eating Disorders


Exercise programmes (Light resistance training) this might be helpful in changing the patient's attitudes towards exercise and also may increase bone and joint strength.

  • Mindfulness training

  • DBT (Dialectical Behaviour Therapy)

  • EMDR

  • Yoga

  • Body Awareness Therapy

  • Estrogen Supplementation

  • Bright Light Therapy

  • Parenting skills training (parents need to create awareness among their children to reduce the risk of an eating disorder behaviors from an early age.)

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