Anorexia
Core Features
BMI <18.5
Deliberate weight loss - not medical reason
Prevention of weight gain - Calorie restriction, exercise, laxatives, purging)
Increased preoccupation with weight, shape
Overestimation of weight
Anorexia
Why? RFx
Female - Young - - Genetics - Co Morbid - ACEs - Personality perfectionism
FH of any MHx - Social Pressures -
Anorexia
What do now?
Severity first - outpatient mostly
Bio - Vitals, Bloods, ECG and weight measurements regularly
Medications can be offered not first line
Treat Co-morbidities - SSRI / Olanzapine
Dietitian support
Psycho - Modified CBT Group therapy
Social - Family involvement higher recovery rates
Anorexia
Risks
Recovery
Osteoporosis
Heart Arrythmias
Amenorrhea
Electrolyte imbalances
Prone to infection
Death
Recovery - 50%
Refeeding Syndrome
Explanation
Body in starvation state
Low insulin, glucose, potassium, magnesium, phosphate
Given large food bolus pushes glucose high
Insulin makes nutrient stores - This depletes everything
Then low levels give risk of cardiac arrythmia and death
Refeeding Syndrome
Mx
Dietitian! Small bolus meals
Regular blood tests (FBC, UE, BP, Mg), vitals and ECG
Give thiamine, Vitamin Co B, Multivitamin
NGT often
Medical bed
1-1 nursing may be required
Refeeding Syndrome
Legal?
May require detaining under mental health act due to lack of capacity to consent for medical treatment
If not under section can arrange MHA triggered by S5:2
Bulimia Nervosa
Explain risks & Treatment
EXPLAIN RISK
Emphasise Physical health Cx - hormones, electrolytes and oesophagus
Most food absorbed from stomach
BIOLOGY - Fluoxetine 60 mg - reduce frequency, Dietitian
PSYCHOLOGY- Guided self help, CBT, interpersonal therapy
SOCIAL - Support for regular eating pattern
Bulimia Nervosa
Does Mx target body weight?
No. Achieving healthy weight is a separate process to the treatment of BN
Delirium Tremens
Core Sx
Define x3
Global confusion, hallucinations, tremor
Severe form of alcohol withdrawal
Medical emergency
Manifest 72-96 hours post last drink
Delirium Tremens
Mx
Long term
BIO
Meds to prevent relapse - Disulfiram, acamprosate
Oral Vit B
PSYCHO
Motivational interviewing
SOCIAL
Community dual diagnosis team
Community services - AA etc
Delirium Tremens
Mx
Initial
BIO-
Treat co-existing medical illness
IV Fluids
CIWA
Chlordiazepoxide (PRN then regular decreasing)
IV Vit B
PSYCHO
1-1 nursing
Side room
Supportive therapy
SOCIAL
Good lighting - use translator
Clock
Delirium tremens
Additional Sx
Tachycardia
Hypertension
Sweating
Fever
Agitation
Insomnia
Delusions
Alcohol related disorders
Criteria
Single episode with harmful use
Harmful pattern of use (30 days vs over a year)
Dependence syndrome
Alcohol dependence
Core Sx
CCU
Harmful pattern of use + 3 Sx
Compulsion/urge to drink
Impaired control over over drinking
Alcohol dependence
Additional features x5
Withdrawals
Tolerance
Neglect
Continued use despite harm
Narrow repertoire
Alcohol dependence
Risks scenario Qs x6
Suicide
Fire/drowning
Co-morbid
Violence
Driving
Physical health
