Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Ego-dystonic sexual orientation wikipedia , lookup
Victor Skumin wikipedia , lookup
Psychological evaluation wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Psychedelic therapy wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Treatment and Management of Adults with Anorexia Nervosa Dr Melanie Bash, Consultant Clinical Psychologist Dr Sylvia Dahabra, Consultant Psychiatrist Treatment and Management Tasks 1. Biological tasks: Weight, height, physiological health, bone density 2. Psychological tasks: Co-morbidity, e.g. depression, motivation for change, individual and group therapy, family therapy 3. Social tasks: Education, occupation, relationships - friends and family Biological tasks at transition • Achieving best skeleton health – Height – Bone density • Physiological health – Puberty and endocrine aspects Marsipan for adults (2014) • Be aware of increased risk of deterioration of physical health during transitions Case discussion • Details omitted re confidentiality Management of physical health Psychological Tasks Collaborative working • Where is the patient in journey through treatment? • Young, not chronic, aim for weight recovery • SEED (5-10 years), need to negotiate and maybe compromise • Goals may be revisited - without deceit • Aims: Ownership and self-efficacy • (Self-efficacy is the extent or strength of one's belief in one's own ability to complete tasks and reach goals) • Aim = get better not feel better Negotiating an appropriate BMI • Important to help patient work to a weight and BMI that are developmentally appropriate. • Ask any dressmaker, weight and shape change with age (!) • Patients often need persuading and reassuring that: e.g. weight in late 20s will look and feel very different from the same weight in early to mid-teens. Treatment does not end with weight gain! • Professionals and patients need to recognise and embrace this. • Weight gain without foundational change is unlikely to be sustained and built upon. • We might know this, important not to overlook it….e.g. “she can have therapy as an outpatient; or “the patient wants to be discharged, they say they can do it”. Our patient’s journey Dietary Development Important to remember that for most people, palate changes with age (studied by psychologists). Most children detest mushrooms and green leafy vegetables. Dietary intake usually improves with maturation. Important to take into account what is normal development, and how normal development might be delayed in AN. Need to work with it, whilst improving intake. Dietary intake • Specialist dietitian Body composition Body image • • • • • Very poor initially Didn’t feel fat at low weight Weight gain provoked some concerns Body image group Explored BI in individual therapy Menstruation • • • • Privacy – hypothetical group exercise Exploring acceptability How to support patient not to do a U-turn First period just before 30 (more later) Exercise and activity – our patient • Wished to improve overall health • Improved BMI (moderately adequate) • Listened and adhered to advice (ED and gym) • Gym became social • Made friends • Had fun • Learned to enjoy her body General mental health • Addressed in CAT therapy • Poor self-esteem (incl. not feeling accepted, and fear of change) • Sense of hopelessness (“I’ll never catch up”) • Grief for lost years and milestones • Tendency to please • Overall tendency to snag progress (no identity outside of AN) What next? • • • • • • • Anxiety about recovery Little education Never worked No friends No relationships No sexual experiences Feeling overwhelmed by the task ahead Tasks to address in therapy • • • • • • • • Taking some calculated risks Education Work experience (DBS; Benefits trap) Interests Friendships Relationships Overcoming family set-backs Professional – supporting, guiding, being a ‘dolphin’. Consistency and reliability. General developmental milestones • • • • • • • • • Late Pace might be faster - or slower Importance of patient’s own speed Birthdays and cake Important birthdays, and making up for loss Sexual relationships Holidays Engagement and marriage (Having children – subject of another talk) Financial skills • Overwhelming fear of adequate budgeting • Ability to spend sufficient on self • Ability to spend sufficient on food • Controlling impulsivity Our patient • Ability to budget and spend £ on food therapy Being realistic • Some difficulties have to be worked around and managed, collaboratively • Bones • Teeth • Parental and some other significant relationships • DBS • Grief for lost time and milestones • Sexual trauma and medium term residual symptoms Working towards a good ending • Working with SEED takes a long time • Patience! • Helping others be patient (the patient, family, commissioners, service managers, colleagues) • Good endings are discussed, agreed and planned. Compromise sometimes necessary. Moving on • • • • For the patient For the professional Final session Keeping in touch??? And boundaries Our patient’s reflections – at discharge • • • • “Not really sure “ Chance to give it another go Professional consistency and reliability Hopefulness from professionals – not giving up • Feeling better about her body (food, activity, using a body with health, fun with clothes and going out) • Living independently and ‘normally’ Final comment • Important to maintain hope • Patients may be more resilient than we give them credit for • Never give up!