* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Eating Disorders in Primary Care
Spectrum disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Conduct disorder wikipedia , lookup
Generalized anxiety disorder wikipedia , lookup
History of psychiatry wikipedia , lookup
Obsessive–compulsive personality disorder wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Child psychopathology wikipedia , lookup
Asperger syndrome wikipedia , lookup
Classification of mental disorders wikipedia , lookup
History of mental disorders wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Rumination syndrome wikipedia , lookup
Abnormal psychology wikipedia , lookup
Eating Disorders in Primary Care Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder (BED) Consider evaluating for an eating disorder if: • • • • • • • • • • • • Precipitous weight changes or fluctuations Sudden changes in eating behaviors (new vegetarianism/veganism, elimination of certain foods or food groups, etc) Sudden changes in exercise patterns, excessive or extreme exercise regimens Body image concerns Abdominal complaints in the context of dieting Electrolyte abnormalities (especially hypokalemia, hypochloremia, or elevated CO2,) Hypoglycemia Bradycardia Amenorrhea or menstrual irregularities Unexplained infertility Type 1 diabetes mellitus with poor glucose control or recurrent DKA Inappropriate use of appetite suppressants, caffeine, diuretics, laxatives, enemas, ipecac, artificial sweeteners, sugar-free gum, prescription medications that affect weight (insulin, thyroid medications, psychostimulants, or street drugs) or nutritional supplements marketed for weight loss DSM-5 Diagnostic Criteria for Anorexia Nervosa A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. Specify: Restricting type Binge-eating/purging type Severity: Mild: BMI ≥ 17 kg/m2 Moderate: BMI 16–16.99 kg/m2 Severe: BMI 15–15.99 kg/m2 Extreme: BMI < 15 kg/m2 Remission: Partial: Used to have all three, now just B (intense fear of weight gain) and/or C (perceptual disturbance) Full: Used to have all three, now none DSM-5 Diagnostic Criteria for Bulimia Nervosa A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa. Type: Purging: during current episode, the person has regularly engaged in self-induced vomiting or misuse of laxatives, diuretics, or enemas Nonpurging: during current episode, the person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas Severity: Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week. Remission: Partial: Used to have all, now only some criteria still met Full: Used to have all, now no criterial still met From Harrington BC, Jimerson M, Haxton C, Jimerson DC Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015 Jan 1;91(1):46-52. PubMed PMID: 25591200. http://www.aafp.org/afp/2015/0101/p46.html DSM-5 Diagnostic Criteria for Binge-Eating Disorder A. Recurrent episodes of binge eating (same as bulimia nervosa) B. Binge eating episodes are associated with three (or more) of the following 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of embarrassment. 5. Feeling disgusted with oneself, depressed, or very guilty after overeating. C. Marked distress regarding binge eating is present. D. At least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior, and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder. Binge Eating Disorder and Morbid Obesity Adults with BED are more likely to have morbid obesity (body mass index > 40 kg/m2) compared to adults without any eating disorder (odds ratio 4.9, 95% CI 2.2-11); nearly one third of these patients meet diagnostic criteria for BED.1 Only 3% of these formally diagnosed. 1. Ivezaj V, White MA, Grilo CM. Examining binge-eating disorder and food addiction in adults with overweight and obesity. Obesity (Silver Spring). 2016 Oct;24(10):2064-9. 2. Cossrow N, Pawaskar M, Witt EA, Ming EE, Victor TW, Herman BK, Wadden TA, Erder MH. Estimating the Prevalence of Binge Eating Disorder in a Community Sample From the United States: Comparing DSMIV-TR and DSM-5 Criteria. J Clin Psychiatry. 2016 Aug;77(8):e968-74. Evidence for Eating Disorder Treatment Modalities Anorexia Bulimia BED Antidepressants Mgmt of comorbid anxiety/depression; limited evidence for effect on sx/weight gain1 Other meds atypical antipsychotics (new limited evidence)1,5 topiramate, naltrexone, odansetron (new limited evidence)2,6 topiramate, naltrexone, orlistat (new limited evidence)6 Therapy CBTª and IPT† equivalent to supportive clinical management.3 CBT is most effective at reducing symptoms; no effect on weight.4 Limited evidence supporting similar efficacy of CBT.5 Therapy+med s Self-guided therapy No evidence for enhanced effect5 Not appropriate5 Clinical improvement RR* = 0.63 (95% CI Similar to bulimia; unclear effect 0.55-0.74); NNT (mean 9 weeks) = 4 (95% on weight loss (consider 2 CI 3-6). Buproprion contraindicated. buproprion).6 36% pooled remission rate for psychological Likely similar to bulimia, orlistat tx compared to 49% for both; and topiramate may enhance NNT (mean 15 weeks) = 8 (95% CI = weight loss6 2 4;320). Limited evidence to suggest improvement in functioning but not remission of binge/purging.5 May be more successful than for bulimia5 *Clinical improvement defined as a reduction of 50% or more in binge episodes. ªCognitive behavioral therapy, CBT †Interpersonal psychotherapy, IPT 1. Claudino AM, Silva de Lima M, Hay PPJ, Bacaltchuk J, Schmidt UUS, Treasure J. Antidepressants for anorexia nervosa. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004365. 2. Hay PPJ, Claudino AM, Kaio MH. Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003385. 3. Carter FA, Jordan J, McIntosh, VVW, Luty SE, McKenzie JM, Frampton CMA, Bulik CM and Joyce PR. The long-term efficacy of three psychotherapies for anorexia nervosa: A randomized, controlled trial. Int. J. Eat. Disord., 2011 44: 647–654. 4. Hay PPJ, Bacaltchuk J, Stefano S, Kashyap P. Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD000562. 5. Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008 Jan 15;77(2):187-95. Review. PubMed PMID: 18246888. 6. McElroy SL, Guerdjikova AI, Mori N, O’Melia AM. Pharmacological management of binge eating disorder: current and emerging treatment options. Therapeutics and Clinical Risk Management. 2012;8:219-241. doi:10.2147/TCRM.S25574. AAFP treatment recommendations From Harrington BC, Jimerson M, Haxton C, Jimerson DC Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015 Jan 1;91(1):46-52. PubMed PMID: 25591200. http://www.aafp.org/afp/2015/0101/p46.html Guided Self-Help for Bulimia Nervosa and Binge-Eating Disorder From Harrington BC, Jimerson M, Haxton C, Jimerson DC Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015 Jan 1;91(1):46-52. PubMed PMID: 25591200. http://www.aafp.org/afp/2015/0101/p46.html Overeater’s Anonymous www.oa.org https://www.oa.org/pdfs/is_food_a_problem_for_you.pdf A Plan of Eating A plan of eating helps us abstain from compulsive eating. This tool helps us deal with the physical aspects of our disease and achieve physical recovery. Sponsorship We ask a sponsor to help us through our program of recovery on all three levels, physical, emotional, and spiritual. Meetings Meetings give us an opportunity to identify our common problems, confirm our common solution through the Twelve Steps, and share the gifts we receive through this program. In addition to face-to-face meetings, OA has telephone and online meetings. Telephone Many members call, text, or email their sponsors and other OA members daily. Telephone or electronic contact also provides an immediate outlet for those hard-to-handle highs and lows we may experience. Writing Writing helps us to better understand our actions and reactions in a way that is often not revealed to us by simply thinking or talking about them. Literature We read OA approved books, pamphlets, and Lifeline Magazine. Reading literature daily reinforces how to live the Twelve Steps and Twelve Traditions. Action Plan An action plan is the process of identifying and implementing attainable actions that are necessary to support our individual abstinence. Just like our plan of eating, it may vary widely among members and may need to be adjusted to bring structure, balance, and manageability into our lives. Anonymity Anonymity guarantees we will place principles before personalities. Service Any form of service that helps a reach fellow sufferer adds to the quality of our own recovery. Food Addicts Anonymous http://www.foodaddictsanonymous.org/ “Food Addicts Anonymous is an organization that believes that Food Addiction is a biochemical disorder that occurs at a cellular level and therefore cannot be cured by willpower or by therapy alone. We feel that food addiction is not a moral or character issue. This Twelve Step program believes that food addiction can be managed by abstaining from (eliminating) addictive foods, following a program of sound nutrition (a food plan), and working the Twelve Steps of the program. After we have gone through a process of withdrawal from addictive foods many of us have experienced miraculous life-style changes.” • Have I tried and failed to control my eating before? • Do I binge-eat, especially when I’m feeling angry or sad? • Do I hide food? • Do I feel guilty when I’m done eating? • Do I think about eating even when I’m not hungry? • Do I eat until I feel sick? From Williams PM, Goodie J, Motsinger CD. Treating eating disorders in primary care. Am Fam Physician. 2008 Jan 15;77(2):187-95. Review. PubMed PMID: 18246888. Don’t forget… 1. Patients with EDs may not acknowledge that they are ill, and/or they may be ambivalent about accepting treatment. This is a symptom of their illness. Patients may minimize, rationalize, or hide ED symptoms and/or behaviors. Their persuasive rationality and competence in other areas of life can disguise the severity of their illness. Outside support and assistance with decision-making will likely be necessary regardless of age. 2. Parents/guardians are the frontline help-seekers for children, adolescents, and young adults with EDs. Trust their concerns. Even a single consultation about a child’s eating behavior or weight/shape concerns is a strong predictor of the presence or potential development of an ED. 3. Diffuse blame. Help families understand that they did not cause the illness; neither did their child/family member choose to have it. 4. Monitor physical health including vital signs and laboratory tests. Clinicians need to remember that physical exam and laboratory tests may be normal even in the presence of a life-threatening ED. 5. Psychiatric risk. Always assess for psychiatric risk, including suicidal and self-harm thoughts, plans and/or intent. Up to 1/2 of deaths related to EDs are due to suicide. From the Academy for Eating Disorders’ A Guide to Medical Care http://www.aedweb.org/images//2016MCSGV3.pdf Resources About Eating Disorders Academy for Eating Disorders http://www.aedweb.org American Academy of Family Physicians http://familydoctor.org/familydoctor/en/diseases-conditions/eating-disorders.html American Academy of Pediatrics http://www.aap.org/en-us/search/pages/results.aspx?k=eating%20disorders American Psychiatric Association http://www.psychiatry.org/mental-health/eating-disorders Centers for Disease Control and Prevention (growth charts) http://www.cdc.gov/growthcharts/charts.htm Families Empowered and Supporting Treatment of Eating Disorders http://feast-ed.site-ym.com/ National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org National Eating Disorders Association http://www.nationaleatingdisorders.org National Institute of Mental Health http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml Society for Adolescent Health and Medicine http://www.adolescenthealth.org/Topics-in-Adolescent-Health/Eating-Disorders-and-Nutrition.aspx