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
Eating Disorders Information for relatives and friends Dr Harry Millar • What are eating disorders? • What are the effects on families and friends? • What help is available? What are Eating Disorders? Anorexia Nervosa • Body weight < 15% below expected or BMI 17.5 or less • Self induced weight loss • Eating restraint • Self induced vomiting,laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics • Body image distortion • Amenorrhoea (Loss of sexual libido in men) Body Mass Index (BMI) Weight in Kilograms/Height in metres squared e.g. 70Kg weight 1.8Metre height 70/1.8x1.8 =70/3.24 =21.6 e.g 37 Kg weight 1.7 Metre height 37/1.7x1.7 =37/2.89 =12.8 Healthy range 20-25 approx Anorexia Nervosa • Body weight < 15% below expected or BMI 17.5 or less • Self induced weight loss • Eating restraint • Self induced vomiting,laxative abuse, excessive exercise, abuse of appetite supressants / diuretics • Body image distortion • Amenorrhoea (Loss of sexual libido in men) F50.2 Bulimia Nervosa Greek: Bous=Ox Limos=Hunger Bulimia Nervosa (F50.2) • Persistent food craving pre-occupation, and binge eating • At least one of • Self induced vomiting, laxative abuse, starvation, abuse of appetite suppressants, thyroid drugs, diuretics • Morbid dread of fatness Other Eating Disorders “Atypical” or Eating Disorder Not Otherwise Specified (EDNOS) – One or more of key features absent – Otherwise can be typical picture – Includes Binge Eating Disorder • Overweight binge eaters • No compensatory behaviours Patients often move from one group to another Fairburn CG and Harrison PJ. Lancet 2003 Symptoms • Fear of uncontrolled eating and weight gain • Binge eating and compensatory behaviours • Distorted body image perception, mirror gazing Distorted Body Image Symptoms • Fear of uncontrolled eating and weight gain • Binge eating and compensatory behaviours • Distorted body image perception, mirror gazing • Pursuit of thinness • Food preoccupation, avoidance, restricted choice • Anxiety eating in company • Guilt after eating • (True loss of appetite) Non specific symptoms • • • • • • Depression, low self esteem and self blame Lack of assertiveness Obsessional, rigid and inflexible thinking Thinking slowed Social withdrawal and irritability Self harm Physical features Anorexia nervosa • Emaciation, Cold extremities, Lanugo • Slow Pulse, low BP • Anaemia/leucopaenia • Hypothermia • Osteoporosis • Oedema • Constipation • Infertility Bulimia nervosa • Electrolyte abnormalities • Dehydration • Parotid enlargement • Hoarse voice • Damaged tooth enamel • Loss of bowel tone • Vomiting blood • Finger Scars - Russell’s sign Effects on Families and Friends Effects on families • Extreme level of burden – greater than schizophrenia • Perplexed about cause – Often self blame by parents – Frustration at other’s lack of understanding • Including professionals • Fear of long term effects – Physical, mental, and social • Helplessness and hopelessness – – – – – Uncertainty about how much daughter can help herself Tried everything – nothing makes any difference Feeling controlled by the illness Interference with family life Difficult to make plans Responses in the family • • • • • • • Sadness up to severe depression Extreme anxiety – fear she will die Spending hours over meals, shopping etc. Anger and hostility Fear of stigma Wishful thinking Externalising the illness – The anorexia as an enemy or alien possession Help for Eating Disorders • Community, voluntary and self help • Primary care • Specialist care Community/self help • Books • Web sites • Support services – beat – NEEDS – NHS services – SEDIG Books – See beat web site click on books from Amazon • Eating Disorders: helping your child recover – S Bloomfield, 2006, Eating Disorders Association • Understanding eating disorders – R Palmer, 2005, Family doctor publications • Anorexia nervosa. A survival guide for families friends and sufferers – J Treasure, 1997, Psychology Press • Skill based learning for caring with a loved one with an eating disorder : the new Maudsley method – J Treasure, G Smith and A Crane, 2007, Routledge • Anorexia and Bulimia in the family – G Smith, 2004, Wiley NICE and QIS Guidance • NICE Eating disorders: anorexia nervosa, bulimia nervosa and related eating disorders Understanding NICE guidance: a guide for people with eating disorders, their advocates and carers, and the public • QIS Eating Disorders in Scotland A Patient’s Guide Some useful web sites • http://www.something-fishy.org – Full of excellent information including a chat room. • http://www.grrr.demon.co.uk/eat.html – Lucy Serpell’s eating disorder resource page has many links. • http://www.anred.com/toc.html - Information about anorexia nervosa, bulimia nervosa, binge eating disorder, and other less-well-known food and weight disorders. • www.anitt.org.uk/ - Click on downloads for care pathways for anorexia nervosa • http://www.iop.kcl.ac.uk/iopweb/departments/home/defaul t.aspx?locator=308 - Institute of Psychiatry • www.patient.co.uk – Links to information and other sites • http://www.rcpsych.ac.uk/ Royal College of Psychiatrists Sources of information, advice, support • Beat – Helplines, 01603 621 414 - under 18, 01603 765 050 – www.edauk.com • Local NEEDS Group – Meetings first Monday of month – 01224 557652 - Answering service – www.needs-scotland.org • North of Scotland Managed Clinical Network (MCN) – 01224 557858 – www.eatingdisorder.nhsgrampian.org • Grampian Eating Disorders Service – 01224 557392 • Scottish Eating Disorders Interest Group (SEDIG) – www.sedig.members.beeb.net Primary care • Usual first point of contact for professional help – variable response • Have continuing responsibility even if patient is seeing a specialist – During normal hours your practice – Out of hours • NHS 24 – 08454 242424 – G-Meds • A and E • Can access psychiatric services via them Specialist Care • Can be – General Medical if uncertain diagnosis or physically unwell – General Psychiatric if urgent or emergency worry about mental state e.g. depression and suicidality – Specialist Eating Disorders (Psychiatric) • For Advice • For Assessment and advice • For Treatment – Usually multiprofessional mental health team – Most patients will just see one or two team members but other team members may advise Grampian Eating Disorder Service Staffing • Consultant Psychiatrist 0.5 • Psychologist 0.8 • CBT therapists 3.0 – Nurses 1.6 – OT 0.4 – Psychologist 0.8 • Dietitian 1.0 • Secretaries 1.0 ?social work, general medical, junior psychiatrist Referral to Triage Assessment • Referral received (usually from GP) ↓ • Referral documented ↓ • Clinical Meeting ↓ • Referral accepted / not accepted ↓ • Opt in procedure with standard letter and questionnaires ↓ • Scoring of questionnaires ↓ • Triage assessment clinic ↓ • Suitable / unsuitable for EDS ↓ • Waiting Lists for Treatment Assessment • Opt in questionnaires • Risk assessment/prioritisation – But don’t do emergency/urgent – GP and General Medical/General Psychiatric Services • Triage Assessment – Extended assessment – In patient assessment • Therapy Assessment • Physical Assessment – In abeyance Telelinks • Peripheral clinics – – – – – – – – Orkney Shetland, Lerwick and Unst Peterhead Fraserburgh Aboyne Stonehaven Elgin Turriff • Priory Hospital • Management meetings Treatment/Management • Individual therapy – Maybe alongside group treatments e.g.Self esteem, body image • Group treatments – Bulimia group – Overeaters group • Video therapy • Dietetic input (alongside other therapy) – Nutritional education - 6 group sessions – Individual sessions • Medical – Medication – Monitoring • Family support Specialist Treatment Strategies • Engage the patient Motivational Interviewing • Psychological treatments • Drug treatments • Hospital admission Psychological Treatments Anorexia Nervosa • Individual Psychotherapy OP. – continuity of care with single therapist who can co-ordinate other aspects of treatment. – long term follow up. • Family therapy / counselling • Group therapy - usually an adjunct – psychoeducational /nutritional/cooking – psychodynamic / CBT Psychological Treatments Bulimia Nervosa • More effective than drug treatment • Cognitive Behavioural Therapy (CBT) – 10 to 18 sessions of one hour (Video?) – response rates of 60-80% • Other techniques eg Interpersonal therapy (IPT) but less available • Individual/Group treatments • Self help/Guided self help/Internet/CD/ Drug treatment Anorexia Nervosa • No drugs affect the course of illness. • Some drugs may help particular symptoms: – Depression - antidepressants – obsessionality – anti–obsessional drugs i.e. clomipramine in low dose / Selective Serotonoin Reuptake Inhibitors (SSRIs) – dietary supplements eg. calcium / oestrogen – ? Antipsychotics e.g. Olanzapine Drug treatment Bulimia Nervosa • SSRI’s – direct but modest anti-bulimic effect – Fluoxetine best tested – Paroxetine and Fluvoxamine don’t work – Need high doses 60mg Fluoxetine • Other drugs as per A.N. • Potassium supplements if low potassium Hospital Admission • What are the aims? – to save life – to treat the disorder – to relieve anxiety (doctors / patient / relatives • Medical of Psychiatric • Voluntary or compulsory Mother of 2 20lbs heavier than 1966