Principles of Managing Anorexia Nervosa

Principles of Managing Anorexia Nervosa Key Information • Often present with medical compilcations such as osteopenia and psycholofucal comborbies such as depression and anxiety. Principles of management • • • • • • • • • Can be challenging, as patient may deny presence of severity Aims: 1. restore body weight to appropriate BMI 2. Help patient have a positive relationship with food and eating by focusing on a good psychological function and mental wellbeing Usually managed outpatient unless: - Meet the admission criteria - Has symptomps that have not improved after several weeks - Is pregnant Due to high mortaility and mobidity, consult a speiclaised eating disorder unit within six weeks of diagnosis to initiate an eating disorder treatment plant Nutritional replichment Psychological therapies No evidence for pharmacological treatment for AN it self, but may be required for associated medical and psyhciatic comorbidies After treatment 40% of patients are symptom free after 5 years - Rest continue to be symptomatic - 20% are severely affected Useful resources: - Butterfly foundations - Center for clinical inntervntions resources for eating disorders - Eating disorders Victoria - Life line - National eating disorder collaboration Considerations for childrenbearing women, pregnancy and postpartum • • • • • Advice patients to delay contraception until in remission - Otherwise outcomes are If have in pregnancy – high risk pregnancy - Should be managed by a specialist perinatal unit Some patients fear adverse outcomes from their eating disorder on the pregnancy - Can lead to time limited remission Others develop recurrence or worsening due to anxiety and fear of loss of control provokved by weighr gain, food cravings and food aversions assoictaed with pregnancy Treatment should be multisplinary: - Obstetrician - Psychiatrist or a spealist eating disorder service - Ditietian - Physician • • • Fetus may require more frequent monitroirn gthat usual: - Blood tests ➔ Anaemia ➔ Thyroid dysfunction ➔ Electrolyte disturbance ➔ Nutritional deficiencies - Ultrasounds ➔ Monitor fetal growth Ideally birth should be given at a tirtiatry hospital with a speiclaist neonatal care and a psychiatric team In postpartum period mothers are: - At an increased risk of relapse because of a combination of stress, sleep deprivation and reduced motivation because infatnt is no longer in utero - More likely to develop postpartum depression - Less likely to persist in breastfeeding Nutritional repleshiment • • • • Inpatient or outpatient Increased risk of reffeding syndrome - Serious and poetntally fatal complication of aggressive feeding of a patient who has been malnutritioned - Hypokalemia, hypomagnesiemia and hypophosphatemia Monitor pshosphate, potassim and mangenisum - Administer electrolyte replacement if required Involve a dietitian Psychological treatment • For children and adolscents - Family based trherapy ➔ Initially recommend ➔ Most effective especially if manualised - Separate family therapy - Adolescent focused therapy - CBT in adolscents Managing psychiatric commodities • • Avoid antidepressants that cause QT interval prolongation For patients with BMI less than 14, start antidepressant treatment at half the usual starting dose. Avoidant/restrictive food intake disorder • • • Little evidence to support use of specific psychological therapies Behavioural refeeding, graded food exposure and cognitive therapies may provide some benefit No evidence to use of pharmacology