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  • Image not available. Clinicians who specialize in the treatment of eating disorders feel that anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified should be commonly accepted as serious mental illnesses.
  • Image not available. Because the causes of eating disorders are complex, multidisciplinary treatment, including pharmacologic and nonpharmacologic interventions, are preferred to ensure a positive outcome. Although outpatient treatment is appropriate for the majority of patients, it is important to recognize the factors that indicate a need for inpatient treatment.
  • Image not available. Careful medical and psychiatric assessments are needed at baseline to determine the severity of illness and the complexity of comorbid conditions.
  • Image not available. In patients with anorexia nervosa, one goal is to achieve and maintain a body weight within 85% of the normal weight for age and height. If the patient is malnourished, oral refeeding with the daily caloric intake starting at 1,000 to 1,600 calories per day (4186 to 6697 J/day) and slowly titrating to 2,000 to 3,000 calories per day (8372 to 12,557 J/day) is preferred. Parenteral refeeding is a treatment of last resort.
  • Image not available. Antidepressants are considered to be ineffective for the core symptoms of anorexia nervosa and are reserved for patients with mood, anxiety, and obsessional symptoms that persist after weight has improved.
  • Image not available. Antidepressants can improve both mood and specific target symptoms in bulimia nervosa, but they remain adjunctive to nonpharmacologic treatments.
  • Image not available. Selective serotonin reuptake inhibitors are first-line agents when medications are indicated for bulimia nervosa. Compared with other antidepressant classes, they have improved tolerability and safety, although superior efficacy has not been studied. The dose of fluoxetine in bulimia nervosa is higher (60 mg/day) than the dose usually used in depression.
  • Image not available. An adequate drug therapy trial in bulimia nervosa is 4 to 8 weeks. If drug treatment fails, consider that the patient may be vomiting or using other purging methods affecting the absorption of the drug.
  • Image not available. The optimal duration of antidepressant treatment for bulimia nervosa is unknown, but most clinicians continue them for 9 to 12 months in patients who respond and then reevaluate the need for ongoing medication management.

Upon completion of the chapter, the reader will be able to:

  • 1. Compare and contrast epidemiologic differences between anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, night eating syndrome, and binge eating disorder.
  • 2. Discuss the potential etiologic factors associated with eating disorders.
  • 3. Evaluate for potential exacerbating factors for eating disorders.
  • 4. Compare and contrast the diagnostic criteria for anorexia nervosa and bulimia nervosa.
  • 5. Discuss the potential future changes in DSM-V diagnostic criteria as it relates to anorexia nervosa and bulimia nervosa.
  • 6. Describe the clinical presentation of anorexia nervosa and bulimia nervosa, both physical and psychiatric.
  • 7. Discuss the medical consequences and potential long-term effects of bingeing and purging behaviors.
  • 8. Identify and assess for common psychiatric disorders that commonly co-occur or mimic the symptoms of eating disorders.
  • 9. Describe the long-term prognosis of patients with anorexia nervosa and bulimia nervosa.
  • 10. Develop a basic set of short- and long-term ...

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