This page contains a Flash digital edition of a book.
CLINICAL: MENTAL HEALTH


initiated in primary care. People with AN should have psychological treatment and


physical monitoring provided by a competent healthcare profes- sional. For AN, the range of therapies recommended is greater and reflects the absence of evidence of the superiority of any specific therapy over others. This is not the case for children and adoles- cents with AN where there is robust evidence of the efficacy of family behaviour therapy (The Maudesley Model). There is no evidence to support the use of medication for the treatment of AN and caution should be exercised in starting medication with side effects which affect the cardiac system due to the compromised cardiac state of individuals with AN.9 Away from the individual, attention should be paid to the needs of family members as they carry a significant burden of care.


RISK The majority of care of those with an ED takes place on an outpatient basis and shared care with the GP/primary care staff is an important aspect of treatment. Key to this is the management of risks associated with EDs which relate to the effects of the ED behaviours; mainly the restriction of food and fluids, and vomiting or laxative abuse. Indicators of increased risk include: Excess exercise with low weight. Blood in vomit. Inadequate fluid intake in combination with poor eating. Rapid weight loss. Fainting. Cardiac symptoms such as chest pain.


Substantial psychological risks exist, in particular that of suicide,


which is increased in those with an eating disorder and should be part of the assessment and management of the individual. Weight/BMI are not sufficient on their own to accurately assess


BOX 2. COMMON BEHAVIOURS IN EDs


Laxative use Individuals who abuse laxatives should be advised to gradually withdraw from them to prevent rebound constipation. Other standard advice about fluid intake and adequate nutrition apply.


Vomiting Individuals should be advised to avoid brushing their teeth following vomiting as this can brush acid into the enamel of the teeth causing damage. Instead they should reduce the acidity of the mouth using an alkaline substance such as bicarbonate of soda diluted in water.


Binge eating Individuals who binge eat should be advised to eat regularly, spreading their intake over 4-5 meals/snacks in the day. They should reduce dieting behaviours and try to eat all types of food.


Weighing Weighing oneself reinforces preoccupation with and attempts to control weight. Individuals should aim to reduce this behaviour and weigh only when necessary such as medical exam or monitoring progress of weight restoration.


risk and it is recommended that BMI should be combined with an examination of muscle strength, blood pressure, pulse rate, peripheral circulation and core temperature.10 case when dealing with children and adolescents.11


This is particularly the Earlier cautions


about the use of medications in AN should also be considered here.


CONCLUSION Eating disorders have a devastating effect not only on the individual with the disorder but also on families and carers. They are difficult to detect, so early recognition of the disorder in primary care will contribute to earlier intervention, and a likely better outcome. Individuals with EDs may reject help due to fear of the consequenc- es, and for all clinicians in primary care, this is best seen as part of the ED, and managed by adopting an understanding approach. An agreement about who is responsible for managing the significant physical and psychological risk associated with EDs is essential between primary and secondary care clinical staff. Lastly, but equally as importantly, the carers and family members of those with EDs should receive support in managing the impact of the disorder.


RESOURCES Beat Eating Disorders www.b-eat.co.uk Royal College of Psychiatrists www.rcpsych.ac.uk National Institute for Health and Clinical Excellence www.nice.org.uk


REFERENCES 1. Surgenor LJ, Horn J and Hudson SM. Empirical Scrutiny of a Familiar Narrative: Sense of Control in Anorexia Nervosa. International Journal of Eating Disorders 2003;33:22-33.


2. Sullivan P. Mortality in anorexia nervosa. American Journal of Psychiatry 1995;152:1073-1074.


3. Zipfel S, Lowe B and Herzog W. Medical Complications. In Treasure J, Schmidt U and Van Furth E (Eds) Handbook of Eating Disorders (Second edition). 2003; Wiley: Chichester.


4. Hoek H and van Hoeken D. Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorder, 2003;34:383–396.


5. Fairburn CG and Cooper PJ. Self induced vomiting and Bulimia Nervosa: An undetected problem. British Medical Journal (Clin. Res Ed) 1982;17:284(6323):1153-1155.


6. Hill S, Reid F, Morgan JF, Lacey JH. SCOFF: the development of an eating disorder screening questionnaire. International Journal of Eating Disorders 2011; 43(4): 344–351.


7. Geller J, Williams K and Srikameswaran S. Clinician Stance in the Treatment of Chronic Eating Disorders. European Eating Disorders Review 2001;9:365-373.


8. Miller WR and Rollnick S. Motivational Interviewing; Preparing People for change. (2nd Edition) New York: Guildford Press; 2002.


9. NICE. Eating Disorders; Core interventions in the treatment and manage- ment of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical Guideline 9. London: NICE, 2004. www.nice.org.uk/CG9


10. Treasure, J. A guide to the medical risk assessment for eating disorders. 2009. Available at: http://www.kcl.ac.uk/iop/depts/pm/research/ eatingdisorders/resources/GUIDETOMEDICALRISKASSESSMENT.pdf


11. Cole TJ, Flegal KM, Nicholls D and Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 2007;335(7612):194.


72 Nursing in Practice March/April 2012


www.nursinginpractice.com


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84