Eating Disorder

diet116I am a bit rusty on this topic.  As a country doc I hadn’t had any eating disorder patients for four years then two have just been referred over recent weeks from the city eating disorder clinic for follow-up.

Also am not sure on what info will be informative because I know that eating disorder patients are generally well read on the subject.

With my two referrals the GP will monitor BMI and biochemistry and I will do the psychotherapy along self-esteem and relationship lines and manage the psychotropics.  I usually use the food and micronutrients as medicine approach and get the patient to divide foods into-  “no”   “maybe” and “yes” categories . We then work to negotiate and experiment more foods from no category to maybe then to yes category. CBT challenges the need to be in control by little exercises of unpreparedness. Generally I find people with eating disorder need a lot of positive acknowledgement of their true self but they initially present their false çompliant self.

The hormonal abnormalities in anorexia are interesting because one day the condition may be treatable by hormonal correction:

Cortisol Releasing Factor – raised        contributes to anxiety

Thyroid hormones – decreased              contributes to depression

Leptin – raised in anorexia                         contributes to satiety and amenorrhoea

Serotonin-  raised in brain                        contributes to satiety

Grehlin    –   raised but body unresponsive  – the hunger hormone

GH, LH,FSH – reduced                                 contributes to amenorrhoea

Medications:

There is a reduced gastric transit time so  +  Metaclopropamide 10mg bd

A low dose of  Clonidine  25mcg  bd also helps with gastric distension

Prozac 60mg/d   for depression

Zyprexa 5mg/d   for anxiety

Topiramate 100mg/d for binge eating

T3 as an antidepressant adjunct.

There may be comorbid conditions notably social anxiety and the Zyprexa wafer which works quickly is handy for this.

Bulimia is best treated in group therapy using psychoeducation, response prevention , topiramate, NAC, guided imagery & cognitive behavioural therapy.

 

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