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![Treatment Modalities (cont.)
Treatment Modalities (cont.)
Psychopharmacology
ƒ Meds that have been used with some success
include:
ƒ For anorexia nervosa:
ƒ For bulimia nervosa:
ƒ For obesity:
ƒ Anorexiants (e.g., sibutramine [Meridia])](https://image.slidesharecdn.com/ch20eatingdisorders-250119152029-dfe4916a/75/Different-Eating-Disorders-Psychiatry-pdf-39-2048.jpg)
![Eating disorders [ Anorexia nervosa, bulimia nervosa, beinge eating]](https://cdn.slidesharecdn.com/ss_thumbnails/eatingdisorders-190423073945-thumbnail.jpg?width=640&height=640&fit=bounds)
Different Eating Disorders Psychiatry.pdf
- 2. Introduction Introduction ƒ The hypothalamus: ƒAn area within the brain that contains the appetite regulation center. ƒ Regulates the body’s ability to recognize:
- 3. Introduction (cont.) Introduction (cont.) ƒEating behaviors are influenced by ƒ Historically, society and culture also have influenced what is considered in the female body.
- 4. Epidemiological Factors Epidemiological Factors ƒIncidence rate of anorexia nervosa among young women in the US is: ƒ Anorexia nervosa occurs predominantly: ƒ Bulimia nervosa is ƒ Bulimia nervosa estimated range: ƒ Onset of bulimia nervosa occurs:
- 5. Epidemiological Factors (cont.) EpidemiologicalFactors (cont.) ƒ Obesity has been defined as: ƒ Approximately 1 in 5 adults are obese.
- 6. Anorexia Nervosa Anorexia Nervosa ƒSymptoms include: ƒ Weight loss accomplished by: ƒ È food intake ƒ Extensive exercise ƒ Self-induced vomiting ƒ Abuse of laxatives & diuretics
- 7. Anorexia Nervosa (cont.) AnorexiaNervosa (cont.) ƒ Weight loss marked with symptoms may include: ƒ Lanugo (soft, fine hair covering all part of body except palms, soles) ƒ Weight loss is extreme, usually more than 15% of expected weight
- 8. Anorexia Nervosa (cont.) AnorexiaNervosa (cont.) ƒ May be an with food: ƒ Compulsive behaviors such as: handwashing present ƒ Psychosocial development generally is delayed
- 9. Bulimia Nervosa Bulimia Nervosa ƒ…..followed by inappropriate compensatory behaviors to rid the body of the excess calories – purging (self- induced vomiting or the misuse of laxatives, diuretics, or enemas). ƒ Binging episodes often occur in secret; only terminated by: ƒ Other ƒ Fasting ƒ Excessive exercise
- 10. Bulimia Nervosa (cont.) BulimiaNervosa (cont.) ƒ Persistent concern with personal appearance, particularly regarding how they believe others perceive them ƒ Weight fluctuation d/t alternating binges & fasts ƒ May experience tears in the gastric or esophageal mucosa ƒ Some are subject to:
- 11. Etiological Implications Etiological Implications AnorexiaNervosa & Bulimia Nervosa Biological Influences ƒ Genetics: ƒ A hereditary predisposition to eating disorders has been ƒ Anorexia nervosa is more common among sisters and mothers of those with the disorder than it is among the general population. ƒ Ç frequency of substance abuse & dependence in relatives with bulimia nervosa
- 12. Etiological Implications (cont.) EtiologicalImplications (cont.) Anorexia Nervosa & Bulimia Nervosa Biological Influences (cont.) ƒ Neuroendocrine abnormalities: ƒ some speculation about a primary hypothalamic dysfunction in anorexia nervosa. ƒ Neurochemical influences: (Theory only) ƒ Bulimia may be associated with the neurotransmitters serotonin and norepinephrine; (+) studies using SSRI’s ƒ Naloxene, an opioid antagonist has shown a (+) weight gain in anorexic pts
- 13. Etiological Implications (cont.) EtiologicalImplications (cont.) Anorexia Nervosa & Bulimia Nervosa Psychodynamic influences ƒ Suggest early and profound disturbances in mother- infant interactions, resulting in: ƒ Unfulfilled sense of separation- individuation
- 14. Etiological Implications (cont.) EtiologicalImplications (cont.) Anorexia Nervosa & Bulimia Nervosa Family Influences ƒ Conflict avoidance ƒ Families may promote and maintain psychosomatic symptoms, including anorexia nervosa, in an effort to avoid spousal conflict. ƒ Unhealthy involvement between family members (enmeshment) & members strive at all cost to maintain “appearances”
- 15. Etiological Implications (cont.) EtiologicalImplications (cont.) Anorexia Nervosa & Bulimia Nervosa Family Influences (cont.) ƒ Elements of power and control ƒ May become the overriding elements within the family. ƒ Parental criticism promotes an Ç in obsessive and perfectionistic behavior on the part of the child, who continues to seek love, approval, and recognition.
- 16. Obesity Obesity ƒ Body massindex (BMI) range for normal weight is: 20 to 24.9 ƒ Overweight BMI is 25.0 to 29.9 ƒ Obesity BMI is > 30.0 ƒ Avg. woman 26.0 and fashion models 18.0
- 17. Obesity (cont.) Obesity (cont.) BiologicalInfluences Genetics ƒ 80% of offspring of two obese parents are obese Physiological factors ƒ Hypothyroidism interferes with basal metabolism & leads to wt gain ƒ Wt gain can occur in response to È insulin in DM ƒ Wt gain can occur in response to Ç cortisone in Cushing Disease
- 18. Obesity (cont.) Obesity (cont.) BiologicalInfluences (cont.) ƒ Lifestyle factors ƒ Ingestion of > number of calories than expended ƒ Sedentary lifestyle
- 19. Obesity (cont.) Obesity (cont.) PsychosocialInfluences ƒ Fixation in the oral stage of psychosexual development ƒ Strong association with: ƒ Excessive optimism ƒ Excessive pessimism ƒ Greed ƒ Demanding ƒ Dependency ƒ Impatience
- 20.
- 21. Diagnoses Diagnoses Diagnosis ƒ Imbalanced Nutrition:< body requirements ƒ Deficient fluid volume (risk for or actual) Diagnosis ƒ Ineffective denial
- 22. Diagnoses (cont.) Diagnoses (cont.) Diagnosis ƒImbalanced nutrition: > body requirements Diagnosis ƒ Disturbed body image/low self-esteem Diagnosis ƒ Anxiety: (moderate to severe)
- 23. Outcomes Outcomes The patient isable to: ƒ Achieve & maintain at least 85% of expected body weight ƒ Show vital signs, blood pressure, & laboratory serum studies WNL
- 24. Outcomes (cont.) Outcomes (cont.) Thepatient is able to: (cont.) ƒ Verbalize ways in which he/she may gain more control of the environment & thereby reduce feelings of helplessness ƒ Express interest in welfare of others & È preoccupation with own appearance ƒ Establish a healthy pattern of eating for weight control, & weight loss toward a desired goal is progressing
- 25. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Imbalancenutrition: < body requirements Deficient fluid volume: risk or actual Interventions: ƒ Dietitian determines # of calories required to provide adequate nutrition & realistic wt gain ƒ Explain that privileges and restrictions will be based on compliance with tx & direct wt gain; do not focus on food & eating ƒ Weigh pt OD, immediately on arising after 1st void, use same scale, strict I &O, assess skin turgor, integrity; assess moistness, color of oral mucosa Rationales:
- 26. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Imbalancenutrition: < body requirements Deficient fluid volume: risk or actual Interventions: (cont.) ƒ Stay with pt during meal time (30 min) and for at least 1 hr following meals ƒ If wt loss occurs, use restrictions. Pt must understand that if nutritional status deteriorates, tube feedings will be initiated. This is implemented in a matter- of-fact nonpunitive way Rationales: (cont.)
- 27. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Ineffectivedenial Interventions: ƒ Develop trusting relationship; convey (+) regard ƒ Avoid arguing or bargaining with pt who is resistent to tx. State matter-of-factly which behaviors are unacceptable & how privileges will be restricted for non-compliance ƒ Encourage pt to verbalize feelings regarding role within family & issued related to dependence/independence, intense need for achievement, & sexuality. Help pt recognize ways to gain control over these problematic areas of life Rationales:
- 28. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Disturbedbody image/low self- esteem Interventions: ƒ Help pt develop realistic perception of body image & relationship with food. Compare specific measurement of pt’s body with pt’s perceived calculations ƒ Promote feelings of control within the environment through participation & independent decision making. (+) feedback will help pt learn to accept self, including weaknesses & strengths ƒ Help pt realize perfection is unrealistic; explore need with pt Rationales:
- 29. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Imbalancenutrition: > body requirements Interventions: ƒ Encourage pt to keep diary of food intake ƒ Discuss feelings & emotions associated with eating ƒ With input from pt, formulate eating plan including foods from basic food groups with emphasis on low-fat intake. It’s helpful to keep plan as similar to pt’s usual eating pattern as possible ƒ Rationales:
- 30. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Imbalancenutrition: > body requirements Interventions: (cont.) ƒ Identify realistic increment for weekly wt loss ƒ Plan progressive exercise program tailored to individual goals & choice Rationales:
- 31. Planning/Implementation(Care Planning) Planning/Implementation(Care Planning) Imbalance nutrition: > bodyrequirements Interventions: (cont.) ƒ Discuss probability of reaching plateaus when wt remains stable for extended periods ƒ Administer medications to assist wt loss if ordered Rationales:
- 32. Treatment Modalities Treatment Modalities ƒThe immediate aim of treatment for eating disorders is to: ƒ Complications of emaciation, dehydration & electrolyte imbalance can: ƒ Once physical condition is no longer life threatening: ƒ other treatment modalities may be initiated
- 33. Treatment Modalities (cont.) TreatmentModalities (cont.) ƒ Behavior Modification
- 34. Treatment Modalities (cont.) TreatmentModalities (cont.) Individual Therapy
- 35. Treatment Modalities (cont.) TreatmentModalities (cont.) Family Therapy
- 36. Treatment Modalities (cont.) TreatmentModalities (cont.) Family Therapy(cont.) ƒ Assists in methods to promote normal functioning of the patient ƒ Support groups
- 37. Eating Disorders Eating Disorders SupportServices ƒ Weight Watchers International ƒ Overeaters Anonymous ƒ National Association of Anorexia Nervosa and Associated Disorders ƒ The American Anorexia/Bulimia Association, Inc.
- 38. Treatment Modalities (cont.) TreatmentModalities (cont.) Psychopharmacology Ø ƒ Various medications have been prescribed for associated symptoms such as
- 39. Treatment Modalities (cont.) TreatmentModalities (cont.) Psychopharmacology ƒ Meds that have been used with some success include: ƒ For anorexia nervosa: ƒ For bulimia nervosa: ƒ For obesity: ƒ Anorexiants (e.g., sibutramine [Meridia])