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

  • image 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 During the process ...

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