I 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
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.