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

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

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

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

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

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

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

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

Excessive protein consumption along with caloric restriction and excessive exercise.

Up to 20%.

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

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

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

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

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

Taking a detailed history of the presenting difficulties.

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

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

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

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.

BMI less than 18.5 kg/m².

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

Less than 18.5.

20 or more weekly sessions, depending on severity.

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

Failure to gain weight as expected based on developmental trajectory.

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

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

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

Developing a positive relationship between the person and the practitioner.

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

Restrictive eating, excessive exercise, and purging behaviors.

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

Females are more affected than males.

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

Regular physical monitoring and multivitamin and mineral supplements if needed.

The link between their symptoms and their abnormal eating behavior.

BMI less than 18.5 kg/m².

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

Frequent, recurrent episodes of binge eating.

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

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

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

To restore weight and establish a weight range goal.

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

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

Self-induced vomiting.

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

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

Using medication as the sole or primary treatment.

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

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

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

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

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

Up to 40 sessions over 40 weeks.

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

A BMI under 14.0 kg/m².

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

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

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

Phosphate, potassium, and magnesium.

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

Dangerously low body weight.

Up to 40 sessions over 40 weeks.

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

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

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

Relevant relationships with others and how these affect eating behavior.

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

To motivate the person and encourage collaboration with the practitioner.

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

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

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

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

Psychoeducation, monitoring of health, and family involvement.

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

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

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

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

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

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

To assist with employment opportunities and supported accommodation.

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

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

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

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

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

Between the ages of 10 and 24 years.

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

Most individuals experience remission.

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

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

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

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

Up to 63% of patients.

35%.

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

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

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

Delayed gastric emptying, constipation, and impaired liver function.

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

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

Lagophthalmos (inability to close the eyelids completely).

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

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