Medical Management of Eating Disorders (PDF)

Medical Management of Eating Disorders www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Medical Management of Eating Disorders Second edition C. Laird Birmingham and Janet Treasure With invited contributions by Donald Barker, Rhonda Brown, Barbara Griffin, Carolina Lopez, Mark Lysyshyn, Sabine Woerwag-Mehta, Ted Slater and Patrick Vos www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  C A M B R I D G E U N I V E R S I T Y P R E S S Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521727105 © C. L. Birmingham and J. Treasure 2010 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2010 Printed in the United Kingdom at the University Press, Cambridge A catalogue record for this publication is available from the British Library ISBN 978-0-521-72710-5 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Contents List of contributors page vii Preface to the second edition ix Preface to the first edition xi List of abbreviations xiii Section 1 Definitions and prevalence 1 Definitions and epidemiology 1 Section 2 Cause 2 Causal and maintaining factors 5 Section 3 Diagnosis and clinical features 3 Obtaining the history and physical examination 15 4 Complications by system 29 5 Complications of nutritional therapy 59 6 Laboratory testing 73 Section 4 Differential diagnosis 7 Differential diagnosis of eating disorders 81 8 Munchausen’s syndrome and eating disorders Section 85 5 Course and prognosis 9 Course and prognosis 89 10 What is the goal weight? 93 11 What is the risk of death? 95 Section 6 Treatment 12 Evidenced-based treatment 97 13 Psychological therapies 107 14 Medical management 119 15 Managing treatment refusal 135 16 Managing medical complications 139 17 Children and adolescents 161 18 Pregnancy 169 19 Geriatrics 171 20 Males 173 21 The chronic patient 175 22 Diabetes mellitus 179 23 Shoplifting 181 24 Substance use 183 25 Self-help treatment 185 v www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Section 7 Obesity 26 Obesity 195 Addendum: Perspectives on treatment Family practice 203 Nursing 209 Dietetics 219 Protocols and algorithms Admission orders for an inpatient eating disorder unit 233 Anorexia nervosa treatment algorithm 235 Bulimia nervosa treatment algorithm 236 Dehydration treatment protocol 237 Glucagon test protocol 238 Magnesium intravenous protocol and balance test 239 Obesity treatment algorithm 240 Parotid enlargement treatment protocol 241 Potassium treatment protocol 242 Warming protocols 243 Bibliography (key references only) 244 Index 257 Colour plate section appears between pages 178 and 179 Contents vi www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Contributors Donald Barker University of Alberta, Calgary, Alberta, Canada (Dietetics) C. Laird Birmingham Professor, Department of Psychiatry, University of British Columbia, Vancouver, Canada Rhonda Brown School of Behavioural, Cognitive & Social Sciences, University of New England, Australia (Chapter 4, Section on Immunity) Barbara Griffin Clinical Assistant Professor, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada (Family practice) Carolina Lopez Division of Psychological Medicine, Institute of Psychiatry, London, UK (Chapter 25, Self-help treatment) Mark Lysyshyn Government of Canada, Ottawa, Canada (Chapter 24, Substance use) Sabine Woerwag-Mehta Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK (Chapter 17, Children and adolescents) Ted Slater Eating Disorders Program, St Paul’s Hospital Vancouver, Canada (Nursing) Janet Treasure Institute of Psychiatry, London, UK Patick Vos Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada (Chapter 16, Section on Superior Mesenteric Artery Syndrome) vii www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Preface to the second edition The Medical Management of Eating Disorders offers the reader a holistic approach to the management of eating disorders, in an easy-to-use handbook style. The reviews of the first edition were very positive – and made good suggestions for the book’s improvement. To facilitate use of the information in the second edition, the format has been altered to that of a standard medical text: definitions and prevalence, cause, diagnosis and clinical features, complications, differential diagnosis, course and prognosis, and treatment. Obesity is dis- cussed next, in Section 7. It is essential that health care professionals who treat eating disorders know the information presented about obesity, so they can understand and discuss these issues with their patients. Chapters therefore include subsections on ‘Implications for health care professionals’ and ‘Patient information’ where appropriate. Janet Treasure has completely revised and updated all text dealing with the psychiatric management of eating disorders, for the second edition. There have been important advances in understanding causal mechanisms that are discussed. These include the importance to causation of social, emotional, perceptual and behavioural cognitive styles. The hope is that treatments can thereby be more closely tailored to the individual. The second edition adds much new material, including: management of eating disorders with concurrent substance use; an approach to the differential diagnosis of eating disorders from the medical perspective; which laboratory tests to order and when to order them; when to perform and how to interpret the glucagon test; how to interpret the magnesium load test; how to diagnose the superior mesenteric artery syndrome; and how to decide whether the patient is at their physiologically normal weight. The chapter on children and adolescents has been completely revised. The outline of history and physical examination has been improved. All major physical signs are now illustrated in colour photographs. The bibliography has been updated, and continues to be limited to only the most important references. We would like to thank everyone who has adopted the first edition of The Medical Management of Eating Disorders as their handbook for the medical care of patients with eating disorders. We invite your feedback on the second edition! ix www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Preface to the first edition This book is rather different from most written on eating disorders. Its sole purpose is to provide assistance to health professionals in the understanding, treatment and management of patients with eating disorders, particularly that part of their treatment that is best described as medical. It is concerned primarily with anorexia nervosa, as it is the member of this group of illnesses that has the most serious medical manifestations, the greatest and longest lasting physical morbidity and the highest mortality rate. However, relevant issues relating to the other eating or dieting disorders are also discussed. The intended audience is predominantly medical practitioners, psychiatrists, physicians, paediatricians and general practitioners – as one of them should always be responsible for the physical health of the eating disorder patient. It is envisaged that the book will also be helpful to other health professionals involved with these patients, particularly nurses, dietitians and also psychologists. The authors intend to produce another book on the same theme but aimed at patients, their families and carers as well as other stakeholders such as schoolteachers and counsellors. It is written partly as a reference textbook, partly as a manual for consultation. The bibliography found at the conclusion of the book will lead the reader to those papers which the authors deem to be the most noteworthy on the various issues surrounding the medical management of eating disorders. Despite the rather authoritarian and dogmatic format, the principal authors acknowledge the limitations of their expertise. They have, between them, more than 60 years of experience in treating eating disorder patients. Whatever success they may have had is because they have stood on the shoulders of those who went before them. They trust that discussion and feedback on the book will improve their clinical practice in future. Eating disorders are orphan conditions: everyone has opinions about them, but no discipline is willing to assume overall responsibility for their care. At one extreme, severe anorexia nervosa with cachexia, multiple nutrient deficiencies, blood and electrolyte abnor- malities and organ dysfunction is a serious physical disease with a chronic course and a high mortality rate. At the other, excessively restricted eating, obligatory exercise and the occa- sional use of purging and vomiting are so common in many developed societies, particularly among young women and adolescent girls, as to be almost the norm. In between these extremes are the psychiatric illnesses of moderate anorexia nervosa, BN, atypical or eating disorder not otherwise specified and perhaps binge eating disorder. These are mental ill- nesses rather than physical diseases, although they may have serious physical manifestations. The dichotomy between mental ‘illness’ and physical ‘disease’ implies an acceptance of a dualistic view of body and mind, or soma and psyche. The authors do not wish to endorse nor refute this dualism. The opposition of dualism to physicalism had been a topic of philo- sophical debate long prior to Descartes’ influential writings in the 14th century – and should remain so. Health care workers or clinicians are practical persons, and as such, they are concerned with the practical issues of maintaining health and combating ill health, not with esoteric issues of ultimate reality. From a clinical viewpoint both a unified and a dualistic approach has advantages. The unified view of body and mind is essential in that almost all of medicine is psychosomatic medicine; psychological factors influence physiological processes and may lead to somatic pathology; physical disease affects the mind both directly and xi www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  indirectly. Thus, from a psychological perspective, we support a unified concept of body and mind. But in the real world of practice we recognize that medicine and the health professions involve two complementary approaches: one is conceived with the anatomical structure and physiological processes of the body and their distortions. The other is concerned with the contents of mind, with emotion and with behaviour and its motivation. The diligent health care worker keeps both in mind, but is careful to distinguish in practice between that which requires physical treatment and that which requires psychological care. Perhaps nowhere else in medicine is the failure to make this distinction as disastrous as it is in respect to anorexia nervosa and its related illnesses. And, paradoxically, perhaps nowhere in medicine is it as important to run the two approaches in a complementary fashion. The therapist – or better, the team of therapists – must be physician, nurse and dietician, as well as psychiatrist, psychologist and mental health nurse. The clinicians treating patients with eating disorders have a complex task. First they must identify and treat that physical disease that is caused by the dysfunctional behaviour and which is manifested in the pathology of malnutrition, chemical disturbance and organ dysfunction. Next, they must attend to the mental illness that may or may not have some physical basis (we don’t know as yet). Third, they must provide help and support in respect to those aspects of these disorders that are best considered as reactions to the dilemma of controlling weight and shape in a society in which obesity has reached epidemic proportions and in which there are strong social pressures to be thinner than most people can achieve. Good luck to those of you who chose to become involved in the management of these demanding patients. Please remember, eating disorders are legitimate illnesses. Those suffering from them deserve the same care and consideration as other sick people. Preface to the first edition xii www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information  Abbreviations AN anorexia nervosa APA American Psychiatric Association AST aspartate transaminase B12 vitamin B12, cyanocobalamin BED binge eating disorder BMI body mass index (weight in kilograms divided by height in metres squared) BN bulimia nervosa cm centimetre CNS central nervous system Cu copper DEXA dual x-ray absorptiometry DSM Diagnostic and Statistical Manual EDNOS eating disorder not otherwise specified EEG electroencephalogram folate folic acid g gram HDL high-density lipoprotein ICD International Classification of Diseases IU International Units JVP jugular venous pressure K potassium kg kilogram l litre LDL low-density lipoprotein mEq milliequivalent Mg magnesium mg milligram ml millilitre mmol millimole P phosphorus PMN polymorphonuclear leukocyte QT interval the time the ventricles (large chambers of the heart) take to recharge electrically QTc the QT interval corrected to the patient’s heart rate RBC red blood cell xiii www.cambridge.org © in this web service Cambridge University Press Cambridge University Press 978-0-521-72710-5 - Medical Management of Eating Disorders, Second Edition C. Laird Birmingham and Janet Treasure Frontmatter More information