Managing Patients with Anorexia Nervosa

Respond to these 3 discussion boards with 2 references each 1. Multidisciplinary Team in Managing Patients with Anorexia Nervosa Bethany’s symptoms indicate that she is suffering from anorexia nervosa, which is the most severe form of eating disorder. Resmark et al., (2019) cite that anorexia nervosa is an eating disorder associated with high morbidity and mortality. It is characterized by a restriction of energy intake, fear of gaining weight and distorted body image, and weight loss, as in the case of Bethany. The DSM 5 states that anorexia nervosa results in severe malnutrition, leading to low body weight and massive health conditions, including cardiac failure. Eating disorders are one of the difficult mental illnesses to treat because of the neurological bases of such disorders. For instance, in anorexia nervosa, the ego-syntonic symptoms reinforce the illness. Additionally, patients with AN perceive the consequences of the disease as positive and adaptive, which promotes treatment resistance and relapse (Abbate-Daga et al., 2013). Therefore, to achieve better patient outcomes, salient components of comprehensive services should be provided by a multidisciplinary team. The multidisciplinary team should include a psychiatrist to assess the patient and lead the team, a school mental health professional, who could be a counselor or psychologist who will ensure that Bethany adheres to recommended interventions such as eating a healthy diet and does not engage in strenuous activities that result in large amounts of calories. A pediatrician will also be a critical component of the team to assess Bethany’s general wellbeing, including her cardiovascular system, initiate treatment of medical conditions resulting from severe malnutrition, and refer the patient to a psychiatrist. A psychotherapist is also a vital team member who will intervene by counseling the patient. Since the hallmark of eating disorders is the disordered beliefs about one’s body shape and weight, the disordered belief should be changed through psychotherapeutic interventions such as cognitive-behavioral therapy and family-based treatment. A dietician is also an essential team member who provides insights about the nutritional requirements of the patient, sets goals with the patient, and recommends preferred diets to aid in achieving optimal weight and BMI.

References Abbate-Daga, G., Amianto, F., Delsedime, N., De-Bacco, C., & Fassino, S. (2013). Resistance to treatment in eating disorders: A critical challenge. BMC Psychiatry, 13, 294.

https://dx.doi.org/10.1186%2F1471-244X-13-294

Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of anorexia nervosa—new evidence-based guidelines. Journal of clinical medicine, 8(2), 153.

https://doi.org/10.3390/jcm8020153 2.

The case study about the adolescent Bethany is a classic case of Anorexia Nervosa (AN), starting from selective food restriction and excessive workout regimen. She even stated that her physician’s scale was inaccurate and believed to be chubbier than the previous weight. Her self-perception of being fat despite being underweight is a prove. AN has a mortality rate 12 times higher than the death rate for all causes of death for females 15 to 24 years old Frank, G et al., 2019). This eating disorder is characterized by an abnormal low body weight with an intense fear of gaining weight and a distorted perception of weight. People with anorexia place a high value on controlling their weight and shape, using extreme efforts that tend to significantly interfere with their lives Frank, G et al., 2019). Some studies have found a specific brain response related to altered processing of visual information or tasks that tested interoception the first goal of treatment is getting back to a healthy weight by learning proper nutrition; and aiding by a reliable team. Those involved in this process may include her primary care physician, who can deliver medical care and manage her calorie needs and weight gain. A psychologist or other mental health professional, who can assist Bethany developing behavioral approaches to aid return to a healthy weight. A dietitian, who will guide her back to normal way of eating by providing particular meal plans and calorie needs to facilitate a steady, graduate weight increase. Her supporting family, who will be participating in helping Bethany maintain normal eating habits. Lastly a mental health therapist who will utilize family-based therapy. This is the only evidence-based treatment for adolescent and teenagers with anorexia. Because the teenager with anorexia is incapable to make good selections about eating and health while in the controls of this dangerous condition, this therapy mobilizes parents to support their child with re-feeding and weight restoration until the child can make good choices about health (Frank, G., et etal 2019). No pills are approved to treat anorexia because none has been found to be potent. However, antidepressants or other psychiatric medicines can aid treat other mental health disorders Bethany may also have, such as depression or anxiety at this moment.

Reference: Frank, G., Shott, M. E., & DeGuzman, M. C. (2019).

Recent advances in understanding anorexia nervosa. F1000Research, 8, F1000 Faculty Rev-504. https://doi.org/10.12688/f1000research.17789.1 . 3

The case study of Bethany shows that she has a fear of becoming fat. She was already mild underweight when she was weighting at 95lbs, and her current BMI is 14.63, which is considered extreme. During her doctor’s visit, she believes that she was chubbier than before, and the weighing scale was incorrect, which shows that she does not recognize the severity of her low body weight. She started to be a vegetarian six months ago and vegan in the last eight weeks, and she is also on gymnastics and the track team, which are persistent behaviors that interfere with weight gain. According to the American Psychiatric Association (2013), she meets the criteria for Anorexia Nervosa, Restricting type (F50.01). Bethany’s mother stated that she started losing weight when she started middle school, a stressful life event. It is also noted that the mom, a first-degree biological relative, has also struggled to be overweight. Being an athlete also encourages thinness. As of now, it didn’t mention any physical symptoms. A multidisciplinary approach would be beneficial for this case: School Mental Health Professionals [SMHP] (can be school counselor, psychologist, social worker, or nurse), psychotherapist, pediatrician, and dietitian. The SMHP can increase awareness and decrease stigmatization and stereotypical views of eating disorders, making the students more comfortable seeking out help in school (Schiele et al., 2020). This role is vital since children are in school every day, and they can link to other resources. A psychotherapist can help by delivering individual or family-oriented approaches such as cognitive-behavioral therapy (CBT), family-based treatment (FBT), and adolescent-focused therapy (AFT). AFT aims at recognizing and dissecting eating disorder symptoms in the context of developmental challenges. In contrast, in FBT, parents’ skills are strengthened to promote their child’s weight gain and the normalization of eating disorder symptoms (Herpertz-Dahlmann, 2017). The pediatrician has the patient’s history, making necessary referrals for the patient and the family. Dietitians are highly educated at university in human physiology, biochemistry, pathology, and eating behavior, contributing valuable knowledge and insight to the team. In addition, they can add in the treatment course- the significance of malnutrition and treating it appropriately and goals of supporting nutritional rehabilitation and establishing a positive relationship with food; the nutritional care process has much to offer beyond a focus on weight and eating behavior ( Jeffrey & Heruc, 2020).

References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Herpertz-Dahlmann, B. (2017). Treatment of eating disorders in child and adolescent psychiatry. Current Opinion in Psychiatry, 30(6), 438–445. https://doi.org/10.1097/yco.0000000000000357

Jeffrey, S., & Heruc, G. (2020). Balancing nutrition management and the role of dietitians in eating disorder treatment. Journal of Eating Disorders, 8(1). https://doi.org/10.1186/s40337-020-00344-x

Schiele, B., Weist, M. D., Martinez, S., Smith-Millman, M., Sander, M., & Lever, N. (2020). Improving School Mental Health Services for Students with Eating Disorders. School Mental Health, 12, 771–785. https://doi.org/10.1007/s12310-020-09387-6

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