Chapter 33 - RCSI Psychiatry Course Book XIII (23-24) p1

BMI < 13 kg/m² (or rapid weight reduction).

Safely refeed the patient, avoid refeeding syndrome, manage fluid and electrolyte problems, and arrange discharge to community care.

20 or more weekly sessions, depending on severity.

Weight in kilograms divided by height in meters squared (kg/m²).

Less than 18.5.

Around 30-60% fully recover, 20% show residual symptoms, and 20% remain chronically ill.

Feeding disorders involve behavioral disturbances not related to body weight or shape concerns, while eating disorders involve abnormal eating behavior and preoccupation with food, often with body weight or shape concerns.

Restrictive eating, excessive exercise, and purging behaviors.

BMI less than 18.5 kg/m².

Self-induced vomiting.

Up to 40 sessions over 40 weeks.

Risk of suicide, chronicity > 5 years, co-morbid impulsive behavior, intolerable family or social situation, failure of outpatient treatment.

Excessive protein consumption along with caloric restriction and excessive exercise.

Managing behavioral problems, assessing patients under compulsion, addressing family concerns, and advising on onward care.

Failure to gain weight as expected based on developmental trajectory.

Significantly low body weight for the individual’s height, age, developmental stage, or weight history.

Patients with anorexia nervosa, chronic alcoholism, oncology patients, postoperative patients, elderly patients, patients with uncontrolled diabetes mellitus, and those with chronic malnutrition.

To restore weight and establish a weight range goal.

Eating-disorder-focused focal psychodynamic therapy (FPT).

Cardiac compromise, respiratory failure, liver dysfunction, central nervous system abnormalities, myopathy, and rhabdomyolysis.

Helping individuals reach a healthy body weight or BMI for their age.

They may be at high risk despite appearing well and having normal blood parameters.

35%.

Refeeding syndrome is a dangerous condition caused by too rapid refeeding; it can be avoided by careful monitoring and gradual refeeding.

They should ensure robust plans are in place with adequately trained medical, nursing, and dietetic staff.

Drawing perceived body size, adjusting light distances, selecting silhouette cards, and using computer techniques.

Frequent, recurrent episodes of binge eating.

The start of symptoms, changes over time, and reasons for avoiding food.

Relevant relationships with others and how these affect eating behavior.

No, it is not an absolute requirement if other behaviors indicate preoccupation with body weight or shape.

A lead physician/paediatrician, a dietitian with specialist knowledge of eating disorders, and a lead nurse.

Older age at onset, male gender, bulimic behavior, chronic illness, excessive weight loss, premorbid obesity, personality disorder.

Intensive community treatment, including outpatient and day patient services for both young people and adults.

Family history of eating disorders or other psychiatric illnesses, and family dynamics such as being rigid, overprotective, or overly controlling.

Appearance and behavior, speech, mood, thought abnormalities, perception, cognition, and insight.

Low self-esteem, depression, poor body image, perfectionism, and rigid thinking patterns.

Anorexia nervosa with significantly low body weight, with BMI between 18.5 kg/m² and 14.0 kg/m² for adults.

Dangerously low body weight.

Inducing weight loss through restricted food intake or fasting without binge eating or purging.

Emaciation, cold extremities, hair loss, amenorrhea, and low blood pressure.

Seizures, peripheral neuropathy, decreased brain volume, and Wernicke encephalopathy.

Anorexia nervosa has one of the highest mortality rates of any mental illness.

Anorexia nervosa, Bulimia nervosa, Binge eating disorder, Avoidant-restrictive food intake disorder, Pica, Rumination-regurgitation disorder, Other specified feeding or eating disorders.

Females are more affected than males.

Restrictive eating, excessive exercise, and extreme fear of weight gain.

Using medication as the sole or primary treatment.

Weight and height (BMI), blood tests (FBC, RFT, LFT, etc.), ECG, CXR, CT brain, DEXA scan, and urine drug screen.

Menstrual changes, symptoms of anemia, constipation, and decreased concentration.

Episodes of binge eating or purging behaviors aimed at getting rid of ingested food.

Dental caries, erosion of tooth enamel, and dry mouth.

To help individuals understand their condition and the problems it causes, linking it to the wider social context.

A condition that can occur when feeding is restarted in patients who have been malnourished, leading to severe electrolyte imbalances.

In many societies, extreme thinness is seen as the standard of beauty and success, leading to dieting pressures.

Developing the therapeutic alliance and addressing pro-anorexic behavior and egosyntonic beliefs.

Transferring the therapy experience to everyday life and addressing concerns about treatment ending.

Between the ages of 10 and 24 years.

Most individuals experience remission.

Amenorrhea, anovulation, infertility, and decreased levels of several hormones.

BMI less than 18.5 kg/m².

Metabolic and hormonal changes during starvation that lead to electrolyte depletion and a rapid change in basal metabolic rate during refeeding.

They may inaccurately perceive their body weight or shape as normal or excessive, often leading to body image distortion.

A BMI under 14.0 kg/m².

Risk assessment, eating disorder rating scales (like EAT or EDI), and depression rating scales (like Beck Depression Inventory).

Low BMI; the lower the BMI, the higher the risk.

Premature death, often due to medical complications of starvation or suicide.

Onset of puberty, break-up of a relationship, death of a loved one, going away to school.

Hypocellular marrow, normocytic or iron-deficient anemia, and leucopenia.

They provide support and training to medical/paediatric wards to manage eating disorder patients.

Taking a detailed history of the presenting difficulties.

Eating disorder history, impulsive behavior, self-harm, and previous contact with psychiatric services.

The link between their symptoms and their abnormal eating behavior.

Current weight and height (BMI), bradycardia, hypotension, thinning hair, lanugo hair, tooth decay, and poor circulation.

Changes in eating patterns, meal settings, quantities and frequency of food intake, concealment of food, and any history of abuse or trauma.

Phosphate, potassium, and magnesium.

Consideration of the most suitable treatment location (inpatient or outpatient) and a multidisciplinary approach.

They often lack recognition that they are underweight or excessively thin.

Death, Russell's sign, dry skin, brittle nails, thinning hair, and osteoporosis.

Syncope, proximal myopathy, hypoglycaemia, severe electrolyte abnormality, petechial rash, and platelet suppression.

Up to 20%.

Abnormal eating or feeding behaviors not better accounted for by another medical condition and not developmentally appropriate or culturally sanctioned.

Regular physical monitoring and multivitamin and mineral supplements if needed.

Cognitive behavioural therapy (CBT), interpersonal therapy, and family therapy.

It is considered a risk factor due to its relationship with adiposity and body dissatisfaction.

To motivate the person and encourage collaboration with the practitioner.

To monitor patients, refer them early, and provide post-discharge monitoring in collaboration with medical services.

Familial faddy eating, undue concern about weight and shape, increased rates of mood disorders among relatives, and rigid family dynamics.

A potentially fatal condition that occurs when patients with severely restricted food intake are given large amounts of food.

Until a full and lasting recovery is achieved, including maintenance of a healthy weight for at least one year.

Sharing the results with them and their family members if appropriate.

It is much more commonly diagnosed in females, with a ratio of 10:1.

A lifestyle choice, using the internet for mutual support and weight-loss tips.

Up to 63% of patients.

Delayed gastric emptying, constipation, and impaired liver function.

Lagophthalmos (inability to close the eyelids completely).

Developing a positive relationship between the person and the practitioner.

Having relatives with anorexia nervosa or a family history of depression or alcohol misuse.

To reduce the risk to physical health and encourage healthy eating and weight.

Up to 40 sessions over 40 weeks.

Aiming for an average weekly weight gain of 0.5 - 1 kg until a target BMI is reached.

Repeatedly checking body weight or using mirrors to check body shape.

By gradually increasing caloric intake and starting vitamin supplementation during refeeding.

To make preventable deaths due to eating disorders a thing of the past.

Decreased cardiac mass, bradycardia, hypotension, and QT interval prolongation.

Psychoeducation, monitoring of health, and family involvement.

To assist with employment opportunities and supported accommodation.