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PATIENT CARE PROCESS

Patient Care Process for the Management of Eating Disorders

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Collect

  • Patient characteristics (e.g., age, race, sex, pregnant)

  • Patient history (past medical, family, social—dietary habits, exercise patterns, laxative use)

  • Weight history and BMI

  • Current medications and prior eating disorder treatment(s)

  • Objective data

    • BP, heart rate (HR), height, weight, and BMI

    • Labs (e.g., serum electrolytes, Scr, eGFR, BUN, metabolic panel)

    • Other diagnostic tests when indicated (e.g., ECG, EEG, bone mineral density)

Assess

  • Symptoms of eating disorders (e.g., anorexia nervosa, bulimia nervosa, and binge-eating disorder) that may include poor body image, weight change, lethargy, binging, purging, GI complaints, etc.

  • Presence of mental health conditions (e.g., depression, schizophrenia, anxiety disorders, etc.)

  • Presence of medical conditions (e.g., malnourishment, cardiac arrhythmia, refeeding syndrome, metabolic acidosis and alkalosis, dehydration, GI complications, osteopenia, osteoporosis, dental problems, etc.)

  • Laboratory abnormalities (e.g., hypokalemia, hypothyroidism, hypomagnesemia, hypophosphatemia, etc.)

  • Current medications that may exacerbate eating disorder symptoms (e.g., diuretics, laxatives, etc.)

  • For the type of eating disorder identified, assess the appropriateness of medication therapy (see Treatment section)

Plan*

  • Nonpharmacologic treatments (e.g., nutritional rehab, education, and counseling; cognitive behavioral therapy; interpersonal psychotherapy; dialectical behavior therapy, family and/or group therapy, etc.)

  • Drug therapy dependent upon the eating disorder identified (e.g., antidepressants, antipsychotics, anticonvulsants, lisdexamfetamine, etc.) (see Figure 64-2)

  • Monitoring parameters including efficacy (e.g., BP, cardiovascular events, kidney health), safety (medication-specific adverse effects), and timeframe

  • Patient education (e.g., purpose of treatment, dietary and lifestyle modification, drug therapy)

  • Self-monitoring of weight, BMI, BP, HR—where and how to record results

  • Referrals to other providers when appropriate (e.g., physician, dietician)

Implement*

  • Provide patient education regarding all elements of treatment plan (nonpharmacologic and pharmacologic)

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Determine changes in eating habits and compensatory behaviors

  • Weight, vital signs and laboratory values

  • Psychiatric (mental status examination) and physical condition stability

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Eating disorders, while no longer considered a controversial psychiatric illness, remain difficult to treat, as comparative effectiveness trials are limited, study methods and outcome measures vary, and patients are often resistant to accepting treatment.

  • Image not available. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separates binge-eating disorder (BED) as an individual eating disorder diagnosis and replaces the category of Eating Disorders Not Otherwise Specified with Specified and Unspecified Feeding andEating Disorders.

  • Image not available. Despite strong genetic associations for the development of eating disorders as established in monozygotic and dizygotic twin studies, a clear association with a specific genetic linkage or mutation has not been identified.

  • Image not available. Shifting between eating disorder diagnostic categories is possible, especially when symptom remission is not achieved with treatment.

  • Image not available. Psychiatric comorbidities are common with all forms of eating disorders, and the differential diagnosis should generally include evaluation for depression, schizophrenia, generalized anxiety, obsessive–compulsive disorder (OCD), and personality disorders.

  • Image not available. During the process ...

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