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Eating disorders - new interest
- marlene m kelbrick (11 January 2006)
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How a child and adolescent service manages anorexia nervosa
- Wessal Abbed (9 February 2006)
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marlene m kelbrick, sho Parklands Hospital, Basingstoke
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kelbrickm{at}aol.com marlene m kelbrick
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I read with interest the article by Bob Palmer (2005), in which he revisited the advances (or lack of them) in the management of Anorexia Nervosa in the last ten years. This comes in a time when it seems there is renewed interest in the subject of eating disorders. This has been contributed to by the recent NICE guidelines published in January 2004, and various recent publications by the Royal College of Psychiatrists, including a Changing Minds campaign (Crisp 2003), an information leaflet (2004), and a document on guidelines for the nutritional management of Anorexia Nervosa (2005). Eating disorders have always been classically associated with young women working in the beauty and fashion industry, with a culture that promotes a stereotyped concept of beauty and thinness. They are now accepted to be affecting (mostly) young women in all walks of life, and also occasionally young men. Eating disorders tend to be neglected and under-reported, with patients unwilling to seek help or engage in treatment. There is a great need for more public awareness of the illness and its consequences. It was therefore very pleasing to read in the recent news about Paula Abdul, an award-winning singer, dancer, choreographer, and celebrity judge on the top-rated TV series 'American Pop Idol', rewarded in New York with the 'Profiles in Living Award' for her work as an ambassador for the American National Eating Disorders Association, having had her own battle with an eating disorder. There is a lack of new substantial research with regards to innovative treatments, but it is to be hoped that this will change in the near future. There are some welcome developments in putting in place more resources, with, for example, plans in my NHS Trust to put in place a new 8 bedded Eating Disorder unit. I therefore hope that in the near future we will have some new advanced effective treatments to offer to our patients, to improve our care and resources, and to offer a better outcome for those who suffer from an eating disorder. |
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Wessal Abbed, Staff grade psychiatry Lincolnshire Partnership
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wessala{at}hotmail.com Wessal Abbed
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We read with interest the article entitled “The management of anorexia nervosa” by Bob Palmer (2006), in which he explored the very few recent advances in the management of anorexia nervosa and outlined the NICE guidelines and their application to the management of anorexia nervosa. We conducted an audit of out patient management of anorexia nervosa in child and adolescence services to compare the local practices in south and west Lincolnshire to NICE guidelines, which involved the retrospective study of 11 case notes for a period of one year. 11 patients attracted a diagnosis of anorexia nervosa based on ICD10 or DSM IV criteria (Male/ Female: 2/9, Age range: 13- 18 year, mean age: 16). 73% were in their first episode. Health belief, physical, and risk assessments had been done in 100% of cases, and all had received growth and developmental monitoring. There was also recorded evidence of social assessment in 92% of the case notes. Dietary counselling had been offered to 90% of patients. Regarding psychological intervention, 100% had individual supportive therapy and 44% family therapy, while only in 33% of cases did the siblings receive supportive intervention. Our audit revealed that, because of physical health deterioration and inability of parents to control the eating behaviour of their child, two thirds of the patients needed admission at some point during the course of their management (42% admitted to a paediatric ward and 57% to specialist tertiary services). According to the NICE guidelines every effort should be made to treat patients in the community. This, however, can prove extremely difficult to achieve due to the interplay of several factors such as rapid and severe weight loss, physical complications, suicidality and an unstable family environment. In these circumstances, in patient management may need to be commenced urgently to save a patient’s life. References Palmer, B. The management of anorexia nervosa . Advances in psychiatric treatment (2006), vol. 12, 5-12. Prestwood C. Out patient management of anorexia nervosa. Progress in neurology and psychiatry (2005); - : 11-13 |
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